Medical Claims Review Team Lead - Telecommute

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

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)

The Team Lead MCR Coordinator provides support to the MCR department in administrative functions. This position utilizes knowledge of Medicare guidelines in order to facilitate and comply with established policies and procedures. The Team Lead functions as a subject matter expert, and provides guidance to MCR Coordinators on more complex issues.

The Team Lead MCR Coordinator will provide float coverage for the MCR department as a resource to staff and support to the supervisor.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
  • Inventory management within MCR Department, primarily regarding problem solving for root cause issues
  • Serve as administrator for RightFax folder, TruCare queues, Portals, and email box to assist with work distribution to coordinators
  • Ensure requests are being processed efficiently and accurately to support quality measures.
  • Perform coordinator audits as assigned
  • Provide coaching and education to all coordinators
  • Responsible for training for new hires and retraining for existing staff as needed
  • Assist with tracking and reporting statistical information regarding volume, trends and provide feedback for efforts to meet department needs
  • Assist with escalated issues, and provides guidance as assigned
  • Collaborate with management with projects as assigned
  • Effective communication 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.

Required Qualifications:
  • High School diploma or GED
  • 2+ years of related experience in healthcare, call center, and/or customer service
  • 1+ years managed care experience in Prior Authorization or Claim Review
  • 6+ months in leadership experience (inclusive of project management)
  • Medical Terminology, ICD-9/10 and CPT knowledge
  • Proficiency with Microsoft Office applications

Preferred Qualifications:
  • Associate Degree
  • 1+ years in leadership experience
  • Excellent verbal and written skills
  • Possess planning, organizing, conflict resolution, negotiation and interpersonal skills
  • Independent problem identification/resolution and decision making skills
  • Ability to interact with individuals and with multidisciplinary teams
  • Ability to demonstrate excellent customer service with patients, providers, and health plan and interacting with other internal departments within the organization

Physical and Mental Requirements:
  • Ability to lift up to 25 pounds
  • Ability to sit for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • 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)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $17.12 to $30.34. The hourly range for Connecticut / Nevada residents is $18.80 to $33.41. 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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Medical Claims Review Team Lead, Healthcare, Claims, Customer Service, San Antonio, TX, Texas, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote

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