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Referral Coordinator

Company: UnitedHealth Group
Location: Noblesville
Posted on: September 21, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing -your life's best work.(sm) -Opportunities with American Health Network, a Part of Optum. When you join American Health Network (AHN), you become part of a team that strives to identify and retain the top healthcare professionals in the markets it serves. At American Health Network, we want to be the best health care organization we can be. Our mission is to improve the health of our patients. We're a physician-led organization, operating over 70 medical offices in Indiana and Ohio, with over 300 providers and 1200 employees. We're also an OptumCare partner, part of the UnitedHealth Group family of businesses, and backed by the resources of a global health care organization working to help people live healthier lives and help make the health system work better for everyone. That's an important differentiator as more people need our help simplifying the complexities of the American health care system. At the same time, the culture of AHN supports work-life flexibility for providers and places a high value on their physical, emotional, financial and other aspects of well-being.The Referral Coordinator is responsible for timely and accurately processing referrals and secures pre- authorizations when necessary. In addition, the Referral Coordinator acts as a liaison between primary care providers, specialists, insurance companies and patients.Primary Responsibilities:

  • Following the process, receives and documents referrals in the referral tracking system, schedules care based on clinical protocols, and sends confirmation of scheduled services to both the referring provider and the patient
  • Accurately enters all referral information into appropriate systems daily in order to facilitate complete medical records
  • Ensures patient demographic and insurance information accompanying the referral is accurate and complete; follows up as needed to obtain missing or correct information
  • Ensures specialists have all clinical information necessary for referral appointments, and sends any additional documents upon request
  • Obtains pre-authorizations and pre-certifications from third-party payers in accordance with payer requirements. Documents the authorization number and period of validity in referral tracking system
  • Gathers additional medical records from providers as needed to support medical necessity when obtaining a pre-authorization, and follows up with payers on pre-authorization requests as needed
  • Identifies and provides information to patients who will need to receive Medicare Advance Beneficiary Notices of No Coverage
  • Alerts the clinicians involved in the patient's care when there are issues with referrals or complications with insurance coverage
  • Informs the patient whether the authorization for the referral has been approved and reviews the next steps of care with them, including providing appointment reminders
  • Collaborates with areas such as financial counseling, care management, and others when patients may need or qualify for additional financial or care coordination programs
  • Establishes and maintains strong working relationships between primary care providers, specialists, and patients. Leverages knowledge of internal primary and specialty care providers and processes to assist in the referral and/or pre-authorization processes
  • Obtains and maintains thorough knowledge of insurance plans accepted by the company as well as preauthorization requirements for contracted commercial and governmental plans
  • Attends meetings and participates on committees as requested
  • Reviews current literature and attends training sessions and seminars to keep informed of new developments and changes within the field
  • Performs other related duties and responsibilities as directed
  • Complies with all company policies and procedures regarding HIPAA and handling of PHI What are the reasons to consider working for UnitedHealth Group? - Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
    • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
    • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
    • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
    • 401(k) Savings Plan, Employee Stock Purchase Plan
    • Education Reimbursement
    • Employee Discounts
    • Employee Assistance Program
    • Employee Referral Bonus Program
    • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
    • More information can be downloaded at: 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 higher) OR -3+ years of experience with referrals and authorizations
      • 1+ years of experience in a healthcare administration or similar role
      • 1+ years of experience with insurance plans, -coding -(ICD-10 and CPT) and -medical terminology
      • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state, and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.Preferred Qualifications:
        • Associate's Degree in healthcare or business administration and/or related coursework, or comparable experience -
        • Experience obtaining pre-authorizations from insurance companies -
        • Ability to interact and communicate with a variety of people, both on a one-on-one basis and/or over the telephone. Must be able to relate to and work with ill, emotionally upset, and sometimes hostile people
        • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
        • Ability to prepare reports and routine business correspondence
        • Proficient computer skills, including working knowledge of Microsoft Office Suite, e-mail systems, and web- based programs. Knowledge of Electronic Health Record systems helpful, NextGen or EpicSoft Skills:
          • Ability to work in a fast-paced office environment
          • Ability to stand and sit for periods of time and to move intermittently throughout the workday
          • Solid -sensory skills, such as visual acuity, good hearing, and dexterity
          • Ability to occasionally push, pull, lift, move, and/or carry up to 15 pounds with or without assistance
          • Good speaking and listening skills
          • Ability to perform focused work with close attention to detail
          • Ability to operate office equipment, including computers, copiers, fax machines, and phones
          • Ability to interact with others, both in person and through phone, e-mail, and written correspondence
          • Excellent customer service skills, for both internal and external parties
          • Excellent communication skills, written and verbal
          • Ability to follow direction
          • Ability to handle multiple tasks simultaneously
          • Ability to demonstrate consistent attention to details
          • Ability to think logically in order to troubleshoot, analyze situations, and make appropriate decisions using critical thinking and problem-solving skillsTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, 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 Optum. -Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do -your life's best work.(sm)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 by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords: #RPO, #Red, Referral Coordinator, American Health Network, Noblesville, IN

Keywords: UnitedHealth Group, Noblesville , Referral Coordinator, Other , Noblesville, Indiana

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