Clinical Admin Coordinator

Clinical Admin Coordinator
Company:

Optum Global Solutions ( India ) Private Limited


Clinical Admin Coordinator

Details of the offer

Positions in this family include those reposnsible for functions in areas such as health services, clinical services and delivery of

clinical care.

Job Function Description
Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the

admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls,

managing requests for services from providers/members, providing information on available network services and transferring

members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior

authorizations. This function includes intake, notification and census roles.

General Job Profile

- Moderate work experience within own function.

- Some work is completed without established procedures.
- Basic tasks are completed without review by others.

- Supervision/guidance is required for higher level tasks.

Job Scope and Guidelines

- Applies knowledge/skills to activities that often vary from day to day.

- Demonstrates a moderate level of knowledge and skills in own function.

- Requires little assistance with standard and non-standard requests.

- Solves routine problems on own.

- Works with supervisor to solve more complex problems.
- Prioritizes and organizes own work to meet agreed upon deadlines.

- Works with others as part of a team.

Additional Scope and Guidelines

Not Applicable

Minimum Educational Background

- High school education or equivalent experience.

Licenses and Certifications

Code Description
Functional Competencies

Functional Competency & Description Proficiency Level

CLA_Receive Medical/Behavioral/Clinical Services or Benefits Requests C) Fully Proficient

-Serve as primary point of contact for providers or members regarding medical/behavioral/clinical services or benefits

-Extract and review fax requests for medical or clinical services

-Receive calls requesting medical/behavioral/clinical services or benefits information (e.g., from providers or members)

-Receive electronic referral form requests for medical/behavioral/clinical services

-Utilize phone system to respond to and transfer calls to appropriate individuals
-Ask callers standard questions to understand requests, gather necessary information, and assess urgency

-Access electronic member files using policy or id number

-Determine member eligibility

-Follow protocols to task requests appropriately

-Check procedure codes against notification requirements and benefit coverage to determine next steps

-Reference automated job aid tools via the computer to identify appropriate procedures when needed

CLA_Research Information to Respond to Medical/Behavioral/Clinical Services or Benefits

Re
C) Fully Proficient

-Access claims information

-Review and interpret call history documentation (e.g., case notes)

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


Source: Timesjobs


Area:

Requirements

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