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UnitedHealth Group Care Team Associate UM Prior Authorization Healthcare WellMed Texas in San Antonio, Texas

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 stat that understands 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.

This is a fast call center environment that requires answering calls and data entry. This position requires working various shift hours and rotating / required weekend.

The Care Team Associate (CTA) for prior authorization department will effectively support the successful implementation and execution of all Utilization Management programs and processes. The Care Team Associate will provide support to the Utilization Management staff to ensure applicable program processes and operational responsibilities are met. The CTA will prepare the authorization by seeking out medical records to the providers via phone or fax, and once completed it is sent to the nurse for review. This position will also provide support in troubleshooting any authorization related issues identified by the Medical Management staff. This position will also assist with training and orientation of new staff and will serve as a subject matter expert for existing staff to ask questions.

If you are located by a WellMed Location, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Receives and responds to inquiries from all communication venues: e.g. phone, queue, department e-mail box or fax

  • Coordinates and assists initial screening of prior authorization requests via all communication venues; as well as administrative preparation for clinical staff

  • Exhibits excellent phone and communication skills while providing complete and accurate information to customers

  • Requests additional or supplemental information via correspondence in order to complete prior authorization requests

  • Completes prior authorizations in the WellMed prior authorization system according to approved policies and procedures

  • Compiles and reports data for ongoing key performance indicators and summarizes and presents findings to departmental leadership. Notifies manager of trends they observe

  • Adheres to assigned schedule and quality metrics

  • Provides clerical and / or administrative support to clinical staff and managers for special studies, projects and reports

  • Provides excellent customer service by serving as a resource to all internal and external customers

  • Attends required meetings and participates in special committees as needed

  • Assists with training and onboarding of Utilization Management Care Team Associates

  • May act as a team lead for projects and departmental initiatives as assigned

  • Performs other duties as assigned

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

  • 2 + more years of administrative support experience

  • Must be able to work independently, with some supervision and direction from manager

  • Possesses medical terminology knowledge base

  • General knowledge of CPT, and ICD-10

  • Must possess and demonstrate excellent organizational skills, customer service skills, and verbal and written communication skills to include but not limited to patients, physicians, clinical staff, contracted providers and managers

  • Working knowledge of Microsoft Office, Internet and e-mail

  • Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times

  • Must maintain strict confidentiality at all times to include but limited to patients and coworkers

  • Must comply with all organizational policies regarding ethical business practices

  • Must adhere to all department policies and procedures

  • 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

Preferred Qualifications:

  • Certified Medical Assistant training or certification

  • 2 + more years of experience with prior authorization or claims

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 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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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, Supervisor, Utilization Management, UM, Medical terminology, ICD and CPT, Claims Coder, San Antonio, Austin, Dallas, Corpus Christi, Fort Worth, New Braunfels, El Paso, 75249, NW PKWY., Texas, TX

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