Senior Clinical Administrative Coordinator - Phoenix, AZ at Optum

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Positions in this function are responsible for checking in, completing new referral intake and onboarding, patient scheduling, answering billing questions and managing patient medical records for a clinic. Roles may vary based on the size of the clinic.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 8:00 PM EST. Our office is located at 20414 North 27th Ave, Suite #450, Phoenix, AZ, 85027.

We offer weeks of paid on-the-job training. New hires will complete 1-2 weeks of Optum new employee onboarding training and then the remainder of training will be done on the job during their normal scheduled shift.

Utilize Computer Systems to pull / verify / enter patient data:

• Access insurance plan systems to verify insurance eligibility/benefits for patients and seek additional information as necessary
• Input/update patient demographic data into computer system
• Update/upload patient care data (e.g., care plan data, inpatient data, patient program flags) in computer systems
• Document patient interactions in appropriate systems/logs (e.g., medication changes)
• Enter/process patient referral data (e.g., medical services, radiology, durable medical equipment)
• Generate reports on patient data through relevant computer systems/applications 
• Review/analyze patient data reports (e.g, discharges, hospital admissions/readmissions, skilled nursing facilities) and follow up as necessary
• Identify inconsistencies in diagnosis/procedure codes and update codes in the system 
• Other duties as assigned

Prior Authorization:

• Review and process all assigned Prior Authorization orders to completion
• Obtain clinical information (including but not limited to medical history, diagnosis, and any relevant lab reports) necessary to complete the Prior Authorization
• Diligently reviews the clinical information for completeness for insurance requirements and follows up with any questions
• Follow the Prior Authorization Criteria for medications and submits requests
• Communicate with insurance companies to pre-certify/authorize medications
• Investigate outstanding medical documentation to ensure a patients account is not suspended
• Assist with any denied claims to resolve potential mistakes by providing clinical information
• Assist with medication change process by providing clinical information
• Clearly support patient experience through patient-centered communications demonstrating excellent customer service skills
• Assist with payer directed patients from receipt through scheduling while actively communicating with all stakeholders.
• Perform duties and job functions in accordance with the policies and procedures established for the department
• Recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed
• Actively participate in problem identification and coordinates resolution between appropriate parties
• Other duties as assigned

Organize / Schedule Patient Services / Appointments:

• Verify referral approval prior to scheduling appointments
• Schedule patients for walk-in or future appointments
• Ask patient questions to verify patient data or needs for scheduling
• Coordinate/confirm scheduling of doctor visits/services with patients 
• Identify resources available to support patient care (e.g., housing, social services, meals)
• Maintain open communication and rapport with physicians to promote patient services/care
• Ensures patient scheduling/follow up activities are completed according to federal, state, or organizational guidelines (e.g., referral guidelines, follow up notifications, PCP follow up) 
• Screens/forwards incoming calls from patients, physicians, and health plans
• Other duties as assigned

Primary Responsabilities:

• Greeting and checking-in patients as they arrive to our centers
• Verifies patient insurance information upon check-in
• Copies insurance cards and driver’s license for all new patients
• Collects patient paperwork and enters patient information into systems, ensuring patient information is accurate and up-to-date
• Review and process all assigned Prior Authorization orders to completion
• Schedule, reschedule, and follow-up with patients for necessary appointments via phone, text, and email
• Manages patient cancellations
• Answer calls within the center and market as appropriate
• General center support i.e. light cleaning, supply ordering/stocking, etc.
• Receiving packages and mail as appropriate

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
• 3+ years of healthcare customer service experience
• 1+ years of experience with benefit verification, prior authorization
• Knowledge of ICD-9/10 and CPT codes
• Understanding of health care insurance: deductibles, copays, coinsurance, out of pocket
• Ability to work 40 hours per week 
• Ability to work any shift between the hours of 8:00 am - 8:00 pm EST, Monday - Friday 
• This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 8:00 PM EST. Our office is located at 20414 North 27th Ave, Suite #450, Phoenix, AZ, 85027

Soft Skills: 

• Knowledge of current authorization regulatory guidelines and requirements
• Excellent organizational, consultative, analytical and problem-solving skills
• Ability to work independently under general supervision and effectively prioritize workload
• Ability to multitask and adapt to fast-paced work environment
• Interpersonal skills
• Ability to collaborate and communicate at all levels of an organization
• Knowledge of basic medical terminology
• Proficiency utilizing EHRs, Practice Management platforms and other software programs
• Multitasking and time-management skills, with the ability to prioritize tasks
• Ability to learn basic medical terminology
• Ability to learn, read, and review insurance plan information and knowledge of insurance portals
• Excellent customer service skills
• Proactive and optimistic
• Enjoy creating a friendly atmosphere
• Good at coordinating with others to meet collective goals
• Team player with ability to work in a fast-pasted environment

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