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Senior Patient Care Coordinator - Phoenix, AZ

UnitedHealth Group

Phoenix, AZ
Job Code:
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Job Details

Senior Patient Care Coordinator - Phoenix, AZ(Job Number:724644)

Position Description:

Healthcare isn’t just changing. It’s growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that’s what fueled these exciting new opportunities. 

Who are we? Optum360. We’re a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we’ll leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide. 

If you’re looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.

As a Senior Patient Care Coordinator with Optum360, you will work with your team members to help identify and resolve issues and serve as a resource for day - to - day operations. Your primary role will be to submit initial and concurrent reviews for authorization and contact insurance companies for follow - up. While ensuring that authorizations are requested, you will provide a full range of Utilization Management (UM) services for assigned hospitals. This position will support the objectives of the Audit Management Unit and the facilities and / or health systems served. This position will play a key role in the certification of inpatient services for all areas served. 

Primary Responsibilities:
  • Knows, understands, incorporates, and demonstrates the Optum360 and client Mission, Vision, and Values in behaviors, practices, and decisions
  • Demonstrating excellent customer service skills by facilitating communication between the hospital facilities and the payers
  • Demonstrating effective assessment skills relative to providing adequate documentation and / or response as requested and / or required by the payers
  • Accommodating payer requests for clinical reviews and Medical Record
  • Facilitating verbal discussion between the respective facility and the payer, as required
  • Becoming knowledgeable of payer assigned time frames
  • Understanding specific payer UM details
  • Collaborating and alerting facility Case Managers of: Additional payer needs, Requests for concurrent or retrospective review, Physician Advisor review
  • Providing support in the certification process to ensure timely authorization of inpatient days followed by timely and accurate documentation
  • Providing communication and / or documentation, as required, in order to ensure concurrent certification and payer updates via MIDAS
  • Facilitating the scanning, copying, and mailing of documents for deferred cases or for cases involved in a concurrent clinical appeal
  • Performing tasks within MIDAS to ensure documentation of TAR and commercial clinical denials
  • Tracking Medicaid / Medi - Cal cases to ensure timely receipt of any concurrent appeal decision by the payer
  • Monitoring payer and State portals and websites for documents related to commercial certification, Treatment Authorization Request (TARs), and Service Authorization Request (SARs)
  • Analyzes and displays data in meaningful formats; develops and communicates policies / procedures and other business documentation; conducts special studies and prepares management reports, including key performance indicators as they relate to the division (waiting / service times, staff productivity, accuracy, patient satisfaction, customer feedback, incident reporting, etc.)
  • Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Optum360’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior
  • Other duties as needed and assigned by the Manager

Job Patient Services
Primary Location US-AZ-Phoenix
Other Location 
Organization O360 Dignity Health Front Ops
Schedule Full-time
Number of Openings 1
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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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