20 days old

Senior Medical Claims Review Coordinator - San Antonio, TX

San Antonio, TX 78205
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Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)


Under the supervision of the Medical Claims Review (MCR) Supervisor, this position is responsible for processing Utilization Management (UM) Inventory. The Sr. MCR Coordinator functions as a subject matter expert, and provides guidance to MCR Coordinators on more complex issues. Sr. MCR Coordinators are responsible for resolution of all claims within their capacity. Sr. MCR Coordinators are responsible for handling claim projects as needed. Sr. MCR Coordinators will be expected to maintain production and quality standards.


Primary Responsibilities:

  • Review claims for duplicates, denials and referrals and ensures that claims information is matched to appropriate authorization
  • Prepares cases for Medical Directors, UM Nurses and Case Managers to conduct clinical review
  • Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
  • Provide guidance and act as a resource to trainers and new hires on benefits, contract interpretations, exclusions, eligibility, policies, standard operating procedures, job aids and workflows to other MCR Coordinators in resolving complex issues
  • Assist with escalated issues, and provide guidance as assigned and maintain prompt turnaround time on all claims and handle priority claims within 24 hours
  • Meet department quality and accuracy standards
  • Interface with other departments to obtain necessary information required for resolution of claims
  • Take ownership of the total work process and provide constructive information to minimize problems and increase customer satisfaction
  • Ensure documentation is completed in appropriate systems
  • Prepare and monitor MCR inventory reports to ensure adherence to turnaround time requirements designated in contracts and/or relevant regulations
  • Effectively communicate with all Supervisors and Directors
  • Performs all other related duties as assigned

You'll 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.

Posted: 2020-05-06 Expires: 2020-06-05

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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Senior Medical Claims Review Coordinator - San Antonio, TX

UnitedHealth Group
San Antonio, TX 78205

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