Data Entry, Utilization Management Coordinator, Healthcare, WellMed - San Antonio, TX
UHG , TX
About the Job
WellMed provides concierge-level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.
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)
Under the supervision of the UM Operations Supervisor, this position is responsible for the daily coordination of UM processes. This position serves as the initial intake of pre-service requests, claim reviews and inpatient hospital coordination. Coordinates UM processes with PHC Medical Directors, UM Nurses, hospitals, physicians and other various PHC departments. Provides clerical support to PHC clinical staff in their medical necessity review process.
Receives and responds to telephone calls through the UM Phone Queue
Coordinates initial screening for UM service requests via phone, web portal, mail and fax
Coordinates initial screening for UM claim reviews through claim queue
Prepares administrative files for Medical Directors, UM Nurses and Case Managers
Performs daily Inpatient Census Reconciliation
Monitors UM inventory to ensure adherence to CMS regulations
Participates in market Patient Care Committees as needed for clerical support
Maintains knowledge of PHC benefits, network, CMS regulations and PHC policies
Conducts provider education sessions on PHC UM processes
Non-clinical staff is not responsible for conducting any UM activity that requires interpretation of clinical information
Performs all other related duties as assigned
This is call center environment located at our office off of Northwest Parkway in San Antonio, TX. The position requires M – F 7AM – 7PM / occasionally Saturday shift
- High School Diploma or GED equivalent
- 2+ years of related experience
- 1+ years managed care experience in Prior Authorization or Claim Review
- Medical Terminology, ICD-9 and CPT knowledge
- Proficiency with Microsoft Office applications
- Medical Assistant (MA) certification
- Associate’s Degree in a healthcare related field
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
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.
Job keywords: Associate Patient Care Coordinator, Patient Services Rep, Patient Care Tech, Medical Office Specialist, WellMed, Clinic, San Antonio, TX