Referral Coordinator USMD Call Center

UnitedHealth Group - North Richland Hills, TX3.6

USMD part of OptumCare is a multi-specialty group of hospital, clinics and physicians. USMD serves the Dallas-Fort Worth metropolitan area with more than 250 physicians and associate practitioners, and provides healthcare services to patients in more than 20 different specialties at its 2 hospitals, 4 cancer treatment centers and nearly 50 physician clinics, many of which are multi-specialty.

The Referral Coordinator is responsible for managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. The referral coordinator also manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles.

Primary Responsibilities:
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
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)
Take calls and questions from members and/or providers regarding case status
Determine whether authorizations are required for requested medical services
Reference automated job aid tools via computer to research relevant rules, regulations, or procedures
Learn computer system and process changes and updates and incorporate into daily work
Contact internal resources if necessary to clarify information
Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests
Provide/explain benefit information to members/providers
Provide/explain authorization information to members/providers
Communicate with clinical team to ensure provider receives a response when necessary

Required Qualifications:
High school diploma or GED
Must have outstanding interpersonal, written, and verbal communication skills. Must possess strong customer service skills.
Proficiency with MS Office products including Word, Excel, Access, PowerPoint and Outlook.
Ability to work effectively with all levels of management and other colleagues.
Ability to multi-task, detail-oriented with strong time management skills. High level of professional integrity and confidentiality

Preferred Qualifications:
1+ year of customer service experience
Experience with ten key
Electronic Medical Records (NextGen and Allscripts)

Physical Demands & Working Conditions:
Ability to withstand prolonged standing and walking with the ability to move or lift at least 50 pounds
Availability to work any hours between 7am to 6pm Monday – Friday
Ability to adapt to frequent scheduling changes (including same day of an assignment)
Availability to work overtime when needed
Careers with USMD. If you’re idea of a great day at work involves putting great new ideas to work, we should talk. Throughout the greater Dallas area, we’ve built an evolving, integrated health care model that brings primary care and specialist providers together to work in new and better ways. A thriving part of OptumCare and the UnitedHealth Group family of companies, our multi-specialty group of hospitals, clinics and providers features more than 250 physicians and associate practitioners. We provide health care services to patients in more than 20 different specialties at our two hospitals, four cancer treatment centers and nearly 50 physician clinics. Join us and start doing 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.