Referral Navigator Representative - Utilization Management - Kelsey Seybold - Remote

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.
The Referral Navigator Representative provides administrative support for the referral navigator department.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:

• This position is primarily responsible for coordinating with KS clinical staff to assist with the entry of prior authorization requests for utilization review
• This includes interpretation and communication of covered benefits and exclusions, prior handling and appropriately directing prior authorization status requests received from KSC staff and assisting with requesting clinical updates
• Other 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.
Required Qualifications:

• High School diploma or GED from an accredited program
• 2+ years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting
• Experience in creating authorization requests or billing Medicare or private insurance companies
• Knowledge of medical terminology, coding, COB payment, and prior authorization processes

Preferred Qualifications:

• Graduate from accredited medical assistant program
• Experience with precertification and/or utilization management
• Knowledge of CPT & ICD 10 Coding methodologies and billing
• Knowledge of insurance payer specific prior authorizations requirements
• Solid knowledge of HMO, PPO, and POS plan types including Medicare and commercial health plans
• Benefit interpretation

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 to $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.