Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)
This position is responsible for processing pending medical claim. MCR Coordinators are responsible for handling claim projects as needed. MCR Coordinators are responsible for making sure claims information is accurate. MCR Coordinators will be expected to maintain production and quality standards.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Review claims for duplicates, denials and referrals and ensures that claims information is matched to appropriate authorization
- Prepares cases for Medical Directors, UM Nurses and Case Managers to conduct clinical review
- Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims
- Provide guidance and act as a resource to trainers and new hires on benefits, contract interpretations, exclusions, eligibility, policies, standard operating procedures, job aids and workflows
- Assist with escalated issues, and provide guidance as assigned and maintain prompt turnaround time on all claims and handle priority claims within 24 hours
- Meet department quality and accuracy standards
- Interface with other departments to obtain necessary information required for resolution of claims
- Take ownership of the total work process and provide constructive information to minimize problems and increase customer satisfaction
- Ensure documentation is completed in appropriate systems
- Effectively communicate with all Supervisors and Directors
- Performs all other related duties as assigned
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.
- High School Diploma or GED equivalent
- 1+ years of experience in healthcare industry
- 6+ months of experience in related managed care in Prior Authorization or Claim Review healthcare
- Proficient with Medicare processing guidelines, working knowledge of medical contracts
- Proficient with Microsoft Office applications
- Knowledge of medical terminology, ICD-9 and CPT knowledge
- Associate’s Degree in a healthcare related field
- Exceptional ability to organize, prioritize and communicate effectively
Physical & Mental Requirements:
- Ability to lift up to 10 pounds
- Ability to push or pull heavy objects using up to a particular pounds of force
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to properly drive and operate a company vehicle
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $15.00 to $25.19. The hourly range for Connecticut / Nevada residents is $15.77 to $27.79. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected bylower 48 law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Medical Claims Review Coordinator, Telecommute, WFH, Work From Home, WAH, Work At Home