Associate Patient Care Coordinator, Benefits and Eligibility - Las Vegas, NV

    • Las Vegas, NV

Position Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Primary Responsibilities:

  • Provide high level of customer service while communicating with internal departments and external provider office staff as pertains to performance of job duties
  • Review and process prior authorization requests to meet departmental key indicator productivity
  • Verifies patient insurance eligibility & benefits to include applicable co-pays, co-insurances, deductibles, Out of Pocket Maximum, appropriate service facilities, services covered and which services if any require prior authorization.
  • Demonstrate knowledge of insurances including navigating websites for online benefit reviews
  • Answer incoming calls regarding benefits, eligibility, authorizations & referrals as well as other inquiries as it relates to health insurance and acts as Patient Advocate
  • Process adverse determinations; timely notification and thorough documentation
  • Respond to complex customer calls
  • Resolve customer service inquiries which could include:
    • Benefit and Eligibility information
    • Authorization for treatment
    • Specialists Orders/Referrals
  • Must be able to work independently
  • Submit Specialists Referrals with appropriate clinical information using established protocols & procedures
  • Exceed attendance standards set by company policy
  • Take responsibility of problem solving

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 education or equivalent experience
  • Knowledge or the ability to learn & apply to job functions
  • Knowledge of benefits & medical terminology
  • Knowledge of local HMO/PPO/Medicare plans preferred
  • Minimum 2+ years experience in a high volume medical clinic required; multi-specialty setting, local HMO experience preferred

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Job Keywords: Associate Patient Care Coordinator, Benefits, Eligibility, Las Vegas, NV, Nevada

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