Referral Navigator Representatives-UM-Kelsey Seybold Clinic

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. 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. Alpha/numeric data entry and basic PC Literacy
• Demonstrate a working knowledge of industry standards processing. Understanding of Health plan benefits and financial obligation interpretation

Preferred Qualifications

• Graduate from accredited medical assistant program
• Knowledge of CPT & ICD 10 Coding methodologies and billing. Prior experience with precertification and/or utilization management
• Knowledge of insurance payer specific prior authorizations requirements preferred Certified medical assistant
• Solid knowledge of HMO, PPO, and POS plan types a plus including Medicare and commercial health plans. Benefit interpretation
• Proven excellent verbal communication and time management skills

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 $16.15 to $28.80 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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. UnitedHealth Group 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. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.