POSITION DESCRIPTION

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) The Referral Coordinator is responsible for managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. The referral coordinator also manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles.

PRIMARY RESPONSIBILITIES:

• Serve as primary point of contact for providers or members regarding medical/behavioral/clinical services or benefits
• Extract and review fax requests for medical or clinical services
• Receive calls requesting medical/behavioral/clinical services or benefits information (e.g., from providers or members)
• Receive electronic referral form requests for medical/behavioral/clinical services
• Utilize phone system to respond to and transfer calls to appropriate individuals
• Ask callers standard questions to understand requests, gather necessary information, and assess urgency
• Access electronic member files using policy or id number
• Determine member eligibility
• Follow protocols to task requests appropriately
• Check procedure codes against notification requirements and benefit coverage to determine next steps
• Reference automated job aid tools via the computer to identify appropriate procedures when needed
• Access claims information
• Review and interpret call history documentation (e.g., case notes)
• Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)
• Take calls and questions from members and/or providers regarding case status
• Determine whether authorizations are required for requested medical services
• Reference automated job aid tools via computer to research relevant rules, regulations, or procedures
• Learn computer system and process changes and updates and incorporate into daily work
• Contact internal resources if necessary to clarify information
• Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests
• Provide/explain benefit information to members/providers
• Provide/explain authorization information to members/providers
• Communicate with clinical team to ensure provider receives a response when necessary

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.

• High school diploma or GED
• Outstanding interpersonal, written, and verbal communication skills. Must possess strong customer service skills
• Proficiency with MS Office products including Word, Excel, Access, PowerPoint and Outlook
• Ability to work effectively with all levels of management and other colleagues
• Ability to multi-task, detail-oriented with strong time management skills. High level of professional integrity and confidentiality

PHYSICAL DEMANDS & WORKING CONDITIONS:

• Ability to withstand prolonged standing and walking with the ability to move or lift at least 50 pounds
• Availability to work any hours between 7am to 6pm Monday - Friday
• Ability to adapt to frequent scheduling changes (including same day of an assignment)
• Availability to work overtime when needed

USMD PART OF OPTUMCARE is a multi-specialty group of hospital, clinics and physicians. USMD serves the Dallas-Fort Worth metropolitan area with more than 250 physicians and associate practitioners, and provides healthcare services to patients in more than 20 different specialties at its 2 hospitals, 4 cancer treatment centers and nearly 50 physician clinics, many of which are multi-specialty. 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.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.