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. This is a call center environment near NW PKWY / M – F: 9AM – 6PM (8HRS) / Rotating - Sat. – Sun.: 8AM – 5PM Primary Responsibilities:Receives and responds to telephone calls through the UM Phone QueueCoordinates initial screening for UM service requests via phone, web portal, mail and faxCoordinates initial screening for UM claim reviews through claim queuePrepares administrative files for Medical Directors, UM Nurses and Case ManagersPerforms daily Inpatient Census ReconciliationMonitors UM inventory to ensure adherence to CMS regulationsParticipates in market Patient Care Committees as needed for clerical supportMaintains knowledge of PHC benefits, network, CMS regulations and PHC policiesConducts provider education sessions on PHC UM processesNon-clinical staff is not responsible for conducting any UM activity that requires interpretation of clinical informationPerforms all other related duties as assigned
Required Qualifications:High School Diploma or GED equivalent 2 or more years of related experience 1 or more years managed care experience in Prior Authorization or Claim Review Medical Terminology, ICD-9 and CPT knowledge Proficiency with Microsoft Office applications Preferred Qualifications: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 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: 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
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.