Peoples Health Authorization Coordinator (DME)

UnitedHealth Group - Metairie, LA3.6

Full-timeEstimated: $40,000 - $55,000 a year
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The Authorization Coordinator (Durable Medical Equipment) (DME) is responsible for reviewing and authorizing requests for DME.

The Authorization Coordinator (DME) reports to the Authorization Division Supervisor and / or Manager and are responsible for the management of assigned DME requests seeking determination. The Authorization Coordinator (DME) is responsible for ensuring and maintaining the mission of Peoples Health as outlined in the Mission Statement.

Primary Responsibilities:
Support health information technology (HIT) in health care quality improvement
Works in coordination company - based security health information systems technology to ensure appropriate documentation of the member’s care coordination and records
Participates in ongoing training to ensure the records are accurate and secure
Follows corporate instruction based on Federal and State guidance related to health information documentation and security
Responsible for receipt, review and documentation of requests for DME
Responsible for inquiry into the system to determine eligibility, duplication of services, and previous authorizations for members
Validates information in request and obtains correct information if necessary
Ensures that compliance timelines and guidelines are met
Forwards all pended authorizations requiring clinical review to the licensed nurse for clinical interpretation and determination of appropriate criteria to review
Understands and complies with PH policies and procedures regarding authorization process flow and organizational determinations, reviews, and other relevant population health policies and procedures.
Assists in obtaining medical / clinical information from the providers as directed by the respective team member, Supervisor or Manager as it pertains to the referral process.
Responsible for tracking information being requested and assuring that the established time frames for authorization division decisions are being adhered to
Responsible for written and / or oral notification to the providers and members when appropriate and approved
Performs research of criteria as required in the authorization division review process using, but not limited to, CMS, PHN policies, InterQual and Hayes review
Refers members to Nurse Practitioner, MSW and / or RN when necessary.
Prepares cases for Medical Director review when appropriate
Non clinical staff will not conduct any activity that requires interpretation of clinical information
When processing an authorization, is responsible to direct any questions or discuss any issues with the licensed health professional who is immediately available
Cross trains to support and maintain administrative activities in the authorization division
Works daily error reports
Responsible for re - authorization of requests that do not require clinical review
Log into phone queue to accept telephone inquiries from providers regarding notifications or authorization numbers
Provides Business Continuity Plan coverage as assigned
Responsible for ensuring that quality outcomes set by the department’s leadership are consistently met to maximize member experiences with service delivery
Performs all other duties as assigned

Core Competencies:
Utilize effective means of both oral and written communication in order to gain members’ comprehension of encounter
Be professional by being prompt, dependable and prepared
Be a team player and to collaborate and work effectively with team members by displaying a helpful, pleasant and positive attitude and a willingness to adapt to change
Comprehend and adhere to policies and procedures
Utilize time management skills efficiently and effectively in order to handle multiple demands of diverse workload, organize and prioritize critical issues in order to meet daily deadlines
Read, comprehend both written and oral communications and apply the information at hand
Work independently and pro - actively and carry - out assignments to completion with minimum assistance
Perform accurate work with a strong attention to detail
Appreciate the diversity of work styles
Display a high level of integrity and respect for confidentiality and adhere to regulatory and PH policies and procedures

Required Qualifications:
High School diploma / GED (or higher)
Computer / typing proficiency to enter / retrieve data in electronic clinical records and documentation systems; experience with email, internet research, use of online calendars and other software applications
Proficiency in Microsoft Office Word to create documents; Outlook to email and calendar organization
Experience in health care and / or managed care

Preferred Qualifications:
Bachelor's Degree (or higher) or business school degree
Experience with medical terminology and / or coding
Understanding of healthcare industry
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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.

Key Words: PeoplesHealth; Metairie, LA; UHC; Clerical; Medicare; authorizations; pre-certification