Medicare Appeals Intake Coordinator

This position is Onsite. Our office is located at 5701 Katella Avenue Cypress, CA 90630

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Internal classification of Administrative Law Judge (ALJ) and / or Medicare Appeals Counsel Coordinator documents with redirection to DDE for documents that belong to another team in ATS and processing of other documents in existing cases to the analysts (i.e., additional information, decisions).  Currently, each of the five coordinators is responsible for classifying all documents received on a specific day of the week.If an expedited Part D hearing or decision is received, the coordinator completes all the coordinator tasks in ATS to get to the analyst to meet compliance timeframes.

Monitoring and processing of emails received in ALJ Team Mailbox on the specific day of the week. This includes responding to emails (or coordinating with Manager when needed), manual addition of a document received into ATS (including combining document and email in Adobe), or forwarding to correct individual on ALJ team or another Team for action to be taken.
On the other 4 days of the week, the coordinator will focus on processing Notice of Hearing backlog cases for assignment to analyst and complete any necessary outreach tasks.

Performing external outreaches to the ALJ Office (i.e., clarification questions or confirming potential legal assistant error in which a member is unlocatable in the system and may have been intended for another plan), sending a document request to physician/facilities to obtain medical records for the case file.

This position is full time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of training will be aligned with your schedule.

 

Primary Responsibilities:

• Processing ALJ Office On the Record (OTR) requests in ATS in collaboration with the analyst on case.  External outreach to the ALJ is required with the plan decision.
• Performing internal outreach to obtain Quality Improvement Organization (QIO) case files and/or QIO Determination letters.
• Performing external outreach to applicable provider/facility for medical records for analyst and UHC Medical Director review.
• Confirming ALJ Team calendar is accurate with case information.
• Communication with analyst to determine if a position statement can be submitted when there are no analysts available.  This may include additional processing of an amended Response to Notice of hearing document to the ALJ Field Office.
• Communicate to management any increased volumes, missed hearings, ALJ decisions indicating plan failed to appear, and/or MAC decisions sent by plan untimely or dismissed.
• Effectively communicates any special ALJ request timelines timely to analysts.
• Creation of clear and concise notes in ATS system for intake document processing or special instructions.
• Processing of required forms externally via ALJ portal or by facsimile.
• Working backlog items when needed from SharePoint.
• Processing coordinator letters or requests for information from ATS tool via ALJ portal or facsimile.
• Keeping track of all items needed from external outreach attempts and/or those needed additional outreach for assigned cases.
• Communication of potential defects or issues in ATS so that a ticket can be created.

Possible additional duties:

• Printing letters received by analysts, completing mailing for Post Office pick up, and noting ATS
• Scanning and processing incoming hard copy mail into ATS and
• Processing CD and thumb drive documents into respective cases in ATS.

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma/GED OR equivalent work experience
• Must be 18 years of age OR older
• 2+ years of experience in a business office environment using telephone and computer as the primary instruments to perform your job duties
• Knowledge of Appeals Process
• Basic knowledge of ATS
• Basic knowledge of GPS
• Proficiency in Centers for Medicare & Medicaid Services (CMS) Appeals Process
• Experience with Microsoft Word (create/edit documents), Excel (sort/filter, tables), PowerPoint (create/edit presentations), Outlook and Adobe Acrobat
• Ability to work full time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.

 

Preferred Qualifications:

• Basic knowledge of medical terminology

 

Soft Skills:

• Excellent verbal and written communication skills

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 – $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment. 

 

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