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Senior Clinical Appeals Coordinator - Eden Prairie, MN

UnitedHealth Group


Location:
Eden Prairie, MN
Date:
12/14/2017
2017-12-142018-01-12
Job Code:
740749
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Job Details

740749 Senior Clinical Appeals Coordinator Eden Prairie MN

Senior Clinical Appeals Coordinator - Eden Prairie, MN (740749)

Position Description

Position Description:
 
 
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.
 
Positions in this function are responsible for providing expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. Communicates with appropriate parties’ issues, implications and decisions. Analyzes and identifies trends for appeals and grievances.
 
Primary Responsibilities:
  • Self-starter who is able to work in a fast-paced environment, able to complete complex tasks quickly with attention to detail.
  • Demonstrated strength in listening, problem solving, organizing and prioritizing.
  • Handle pharmacy appeals cases that require clinical review includes verifying the need for clinical review.
  • Verifying necessary documents.
  • Verifying Member coverage and clinical programs that .
  • Routing cases to the correct Pharmacist queue or Medical Directors (when required).
  • Assure appeals are resolved within regulatory timeframes.
  • Research and help resolve customer complaints submitted by consumers or UnitedHealth Group executives when asked by DOI / Consumer Affairs / UHC Pharmacy leadership.
  • Assure grievances / complaints and DOI issues are handled within regulatory timeframes.
  • Resource for many internal departments for pharmacy appeals questions including status update and routing assistance or determining if an appeal is necessary and appropriate.
Required Qualifications:
  • High School Diploma / GED
  • Current Pharmacy Technician Certification (State or National)
  • 1+ years of Healthcare Insurance or Pharmacy Authorization experience
  • Candidates must be able to create, edit, copy, send and save documents, correspondence and spreadsheets in Microsoft Excel, Microsoft Word, and Microsoft Outlook 
  • Must be able to work Mon - Fri 10:30 am to 7:00 pm CST 
Preferred Qualifications:
  • Some College
  • Previous Pharmacy experience
  • Prior professional Appeals experience
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, Military families and Veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life’s best work.
 
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.
 
Keywords: Eden Prairie, MN, appeals, grievance, pharmacy, pharmacy technician, certified pharmacy technician

Job Details

  • Contest Number740749
  • Job TitleSenior Clinical Appeals Coordinator - Eden Prairie, MN
  • Job FamilyMedical and Clinical Operations
  • Business SegmentUHC Clinical Services

Job Location Information

  • Eden Prairie, MN
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftEvening Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

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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