Our customer service & claims teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service and across our global economy. Join us and find out why this the place to do your life's best work.SM
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)
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.
Under the supervision of the UM Operations Supervisor, this position is responsible for the daily coordination of UM processes in the Intake Call Center. This position serves as the initial intake of pre - service requests, claim reviews and inpatient hospital coordination and diabetic supplies. Coordinates UM processes with Medical Directors, UM Nurses, hospitals, physicians and other various departments. Provides clerical support to clinical staff in their medical necessity review process. UM Coordinator is expected to maintain production and quality standards.Primary Responsibilities:
- Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
- Providing excellent customer service, including the ability to handle escalated callers
- Determining authorization or notification requirements
- Preparing authorization cases for Medical Directors, UM Nurses and Case Managers
- Providing administrative approvals (depends on line of business)
- Handling expedited authorizations, authorization updates and status checks
- Confirming member eligibility
- Responsible for outreaches to providers and / or Patient to complete authorization requests and prescriptions
- Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
- Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
- 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 a call center environment near Lockhill Selma Rd. / Dezavala / IH-10 / Loop 1604, San Antonio, TX, 78249, Mon - Fri: 9AM - 6PM (8HRS) / Rotating Sat - Sun: 8AM - 5PM.
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 equivalent
- 2+ years of previous related experience in any of the following or combination thereof: healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
- Medical Terminology, ICD - 9 / ICD-10 and CPT knowledge
- Proficiency with Microsoft Office applications, i.e., Excel, Access, Outlook
- Ability to work the hours of 9am - 6pm, Monday - Friday and the hours of 8am - 5pm on rotating weekends and holidays
- Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive VoiceResponse (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
- You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations
Physical & Mental Requirements:
- Associate's degree in a healthcare related field
Careers with WellMed.
- Ability to lift up to 10 pounds
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and / or machinery
- Ability to properly drive and operate a company vehicle
- Ability to receive and comprehend instructions verbally and / or in writing
- Ability to use logical reasoning for simple and complex problem solving
Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ 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)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
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: WellMed, Healthcare, Bilingual, Data Entry, Associate Patient Care Coordinator, Patient Services Rep, Patient Care Tech, Medical Office Specialist, Call Center, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne,78249, NW Pkwy., Texas, TX