Clinical Administrative Coordinator

** Requisition number:
** 2383916

** Job category:
** Medical & Clinical Operations

_This position is National Remote. You'll enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges._

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start  
** Caring. Connecting. Growing together.*
* The  
** Optum Care Clinical Administrative Coordinator
** team is responsible for the initial triage of clinical claim reviews, administrative preparation of cases for nurse review and working with others in claims operations and clinical teams. The initial triage includes using departmental resources to validate the appropriateness of the case for the Medical Claim Review nurses. The Clinical Administrative Coordinator is responsible for verifying claim information, member eligibility, related utilization management and prior authorization information in the claims payment system.

This role includes managing clinical letters as directed by the nurses.

This position is full-time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 4:30 pm. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of paid training. The hours of training schedule might adjust based on training availability.

*
* Primary Responsibilities:

*
* + Access claims information in the claims payment system

+ Determine if Medical Claim Review is required for the service(s) using department resources (e.g., job aids, prior-authorization lists, MCR Code List)

+ Verify member eligibility

+ Determine health plan and network

+ Verify prior authorization and/or inpatient utilization review information in claims payment system

+ Create and send letters to providers as directed by nurses

+ Follow standard procedures to complete work, including departmental job aids and policies

+ Learn computer system and process changes and updates to incorporate into daily work

+ Navigate between computer screens and platforms to research information (e.g., medical, clinical or benefits information)

+ Applies knowledge/skills to activities that often vary from day to day

+ Works with others as part of a team

+ Prioritize and organize work to meet deadlines

+ Work with supervisor to solve more complex problems

+ Other duties assigned by leadership

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

+ Ability to type 45 Words Per Minute

+ Computer literacy, Microsoft Office Suite (Microsoft Word & Microsoft Outlook)

+ 1+ years of medical claims review OR claims processing experience

+ Ability to work full-time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 4:30 pm. It may be necessary, given the business need, to work occasional overtime

*
* Preferred Qualifications:

*
* + 2+ years administrative experience in healthcare setting

** Telecommuting Requirements:*
* + Ability to keep…