Part Time Clinical Administrative Coordinator

About the position

The Part Time Clinical Administrative Coordinator at Optum is responsible for processing Utilization Management (UM) Inventory under the supervision of the Medical Claims Review Supervisor. This role involves acting as a subject matter expert, providing guidance to MCR Coordinators, and ensuring the resolution of claims. The position requires maintaining production and quality standards while working in a hybrid environment, with three days onsite and two days remote.

Responsibilities
• Review claims for duplicates, denials, and referrals, ensuring claims information matches appropriate authorization.
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• Prepare cases for Medical Directors, UM Nurses, and Case Managers for clinical review.
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• Provide expertise in claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims.
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• Act as a resource for trainers and new hires on benefits, contract interpretations, exclusions, eligibility, and workflows.
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• Assist with escalated issues and maintain prompt turnaround time on all claims, handling priority claims within 24 hours.
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• Meet department quality and accuracy standards.
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• Interface with other departments to obtain necessary information for claims resolution.
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• Take ownership of the total work process and provide constructive feedback to minimize problems and increase customer satisfaction.
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• Ensure documentation is completed in appropriate systems.
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• Prepare and monitor MCR inventory reports to ensure adherence to turnaround time requirements.

Requirements
• High School diploma/GED
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• 2+ years of related managed care experience in Prior Authorization or Claim Review healthcare, and/or customer service
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• 1+ years in the healthcare industry
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• Knowledge of medical terminology, ICD-9, and CPT
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• Proficiency with Microsoft Office applications
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• Proficient with Medicare processing guidelines and working knowledge of medical contracts
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• Ability to work any of the 8-hour shift schedules during normal business hours of 7:00 am – 4:00 pm.

Nice-to-haves
• Ability to organize, prioritize, and communicate effectively.
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• Ability to provide excellent customer service to a varied customer base.
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• Ability to navigate multiple systems.
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• Ability to work in a fast-paced environment.

Benefits
• Comprehensive benefits package
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• Career development opportunities
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• Flexible work environment with hybrid options