1+ months

Medical Management Coordinator - ProHealth Physicians - Farmington, CT - 924482

Farmington, CT 06032
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  • Job Code
    924482

If you want to get way ahead in your career, it makes sense to be with an organization's that's way ahead of the curve. Formed in 1997, ProHealth Physicians has grown to become Connecticuts leading primary care physician organization. With over 90 locations throughout the state of Connecticut, our family of primary care doctors and specialists care for more than 360,000 people statewide. In fact, ProHealth serves every county and provides roughly ten percent of the primary care delivered to patients in the state. We're leaders in thinking and in serving our communities. For instance, we're a C.M.S. approved Accountable Care Organization (ACO), covering over 30,000 Medicare patients associated with our community-based primary care providers. We're also nationally recognized as a NCQA Level III Medical Home. That kind of progressive leadership makes us perfect fit for OptumCare and UnitedHealth Group's expanding family of providers. This is a place where you can stay way ahead as you do your life's best work.(sm)

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Medical Management Coordinator is responsible for various non-clinical tasks performed in support of the UM authorization process. Medical Management coordinator may interact with Members, providers, hospitals and other facilities. Medical management coordinator will also work closely with Utilization Management to generate timely and compliant denial letters and to facilitate the submission of appropriate appeal documentation, according to standards. Compiles and maintains denial letter and appeal files. Responsible for reporting of appeals and denials to Utilization Management / Compliance / QI.

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Primary Responsibilities:

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  • Provides referral authorization to providers, and members
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  • Organizes and maintains filing system of authorization / referral hard copies
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  • Inputs ICD10 codes and CPT codes into computer for referral
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  • Prepares assigned correspondence and reports and compiles statistical date as directed
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  • Receives and reviews UM authorization request submitted via mail, fax, phone, portal
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  • Determines whether authorization and /or referrals are required for requested services
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  • Navigates between multiple computer screens and platforms to research / access / enter pertinent information
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  • Enter information into applicable systems
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  • Process authorizations referencing job aides and standard policies and procedures to research relevant rules, regulations or member specific requirements
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  • Collaborates with internal and/or external stakeholders to correct errors, issues or concerns identified with the files
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  • Meets quality and turn-around times
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  • Once a denial is issued, responsible for development and timely submission of denial letters, within the set parameters of ONCT and contracted Health Plans. These letters include, but are not limited to: denials generated for acute inpatient services, denied pre-authorization requests and changes in level of care
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  • Works closely with UM / QI / Compliance to insure that denial letters have appropriate language as delineated by ONCT, the Health Plans, CMS and DMHC
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  • Once an appeal is filed, responsible for the coordination and timely submission of a response to the health plan (e.g. clinical documentation, copies of referral requests and denial letters), within the set parameters of ONCT and the appropriate Health Plan. These appeals include: appeals generated from denials on acute inpatient stays, pre-authorization requests and SNF level of care issues. Analyzes appeal cases in question for appropriateness of denial through detailed review of records. Issues and follows up on overturn / upheld determination letters. Works HELD report to maintain timely reporting
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  • Responsible for keeping computerized records for submission to UM/QI for quarterly and annual reports, as well as to individual health plans and groups as required. Maintains and organizes all electronic denial files. Accurately uses database and systems for documentation, tracking and trending
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  • Reviews denied authorizations and appeal files for completeness. Follows up as appropriate for questions, clarification and correction
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  • Follows policy and procedures regarding the denial / appeal process. Orients internal staff to current changes in the denial process
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  • Assists with QI / Compliance projects as assigned
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  • Other duties as may be assigned
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Youll 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.

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Required Qualifications:

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  • High School diploma
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  • 4+ years of administrative office experience in health care delivery setting in hospital, clinic, or physicians office
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  • Proficient in Microsoft Office, experience using databases
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  • Experience reading and interpreting information with excellent comprehension and retention
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  • You will be asked to perform this role in an office setting or other company location
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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  • Associates Degree
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  • Knowledge of general IPA operations
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  • Familiarity with governing entities (CMS, DMCH and NCQA)
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  • Medical Terminology Certificate
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  • Medical Assistant experience
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  • Sound decision making, critical thinking and analytical skills
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  • Excellent written and verbal communication skills
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  • Excellent interpersonal skills and professional demeanor
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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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.
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"UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: MA, Medical Assistant, Primary Care, Billing, ICD-10, CPT, Medical Receptionist, Care Coordinator, Farmington, CT, Connecticut
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Posted: 2021-05-06 Expires: 2021-07-04

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Medical Management Coordinator - ProHealth Physicians - Farmington, CT - 924482

UnitedHealth Group
Farmington, CT 06032

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