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UnitedHealth Group Utilization Management Coordinator Healthcare WellMed San Antonio TX in San Antonio, Texas

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing 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.

The Associate Patient Care Coordinator provides support to the UM department in administrative functions for UM organization determinations and appeal coordination. This position utilizes knowledge of Medicare and state HMO guidelines in order to facilitate and comply with the Utilization Management plan in data entry and to prepare letters utilizing standard templates. The Associate Patient Care Coordinator will also provide float coverage for the central UM department, utilizing and following established policies and procedures.

If you are located within commutable distance from WellMed office, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Provides data entry, filing, tracking time frames and status of case files and mailing letters to patients and providers.

  • Reviews denials and determines whether the decisions are retro/ claims DOS or prospective DOS, and whether they are NCB or medically necessary. Sorts appropriately.

  • Monitors system approval queues and prints member letters, ensuring that all approvals are printed and mailed by end of business day.

  • Prepares envelopes and letters for mailing according the UM policy.

  • Receives appeal requests from health plans and/ or QIO, logs requests, researches and provides requested information.

  • Works with claims department to redirect claims related appeal requests.

  • Generates reports for analysis by department using the data entry system.

  • Assists with CMS organization determination reports as needed

  • This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours.

This is an office based (call center) position located near Northwest PKWY in San Antonio, TX.

The position requires working various shifts including evenings, weekends and holidays as determined by the business

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+ years of related experience

  • Sound knowledge of medical terminology

  • Proficient software computer skills

  • Possess planning, organizing, conflict resolution, negotiation and interpersonal skills

  • Independent problem identification / resolution and decision making skills

  • Ability to interact with individuals and with multidisciplinary teams

  • Ability to demonstrate excellent customer service with patients, providers, and health plan and interacting with other internal departments within the organization

  • You will be asked to perform this role in an office setting or other company location

  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (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

Preferred Qualifications:

  • Related experience in healthcare

  • Familiarity with ICD - 9 coding

  • Excellent verbal and written skills

  • Telephonic and/or telecommute experience

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The hourly range for Colorado residents is $15.00 to $25.19. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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

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, Supervisor, Utilization Management, UM, Medical terminology, ICD and CPT, Claims Coder, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, Texas, TX

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