Medical Claims Review Coordinator for WellMed - San Antonio, TX - Full-time / Part-time

The hours for this position are Monday - Friday 9am to 6pm.  There will be some occasional overtime as needed on Saturdays.
 
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)
 
Start your healthcare career with WellMed!
 
Great entry level position in healthcare!  In this position you will interact with patients and their  family members, healthcare providers,  insurance companies.  Learn from healthcare experts as you work side by side to improve the lives of patients!  Enjoy profound job satisfaction as you impact the care and comfort of our aging population.  We offer  the benefits of working for a large, multi-national company – career opportunities, great benefits, paid time off, and more!   The successful candidate will demonstrate effective customer service and communication skills. 
 
Primary Responsibilities:           

Answering incoming calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
Analyze and apply denials
Process and Review Claims
Excellent Data Entry Skills needed
Experience in Contract Interpretation
Medical Insurance Industry processing
Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member / provider
Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
Analyze and identify trends and provides reports as necessary
Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance
Ability to work on various other projects as needed

Required Qualifications:            

1 year of Medical Claims Experience
Working knowledge of Medical Terminology, ICD9-ICD10, CPT4, UB92 / 1500 forms
Excellent Data Entry Skills
Basic experience with Microsoft Word, Excel, Access
Excellent communication skills
Demonstrated problem solving skills
Good organization skills
Ability to work independently and as part of a team
Ability to work overtime as needed, based on department needs
 
Preferred Qualifications:

Medical coder and/or involved with medical coding
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 90,000+ 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: claims, health insurance, healthcare customer service, san Antonio, tx, denials, claims review