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 Medical Directors, UM Nurses, hospitals, physicians and other various departments. Provides clerical support to clinical staff in their medical necessity review process. Primary Responsibilities:
- Receives and responds to telephone calls through the UM Phone Queue
- Coordinates initial screening for UM service requests via phone, web portal, mail and fax
- Coordinates initial screening for UM claim reviews through claim queue
- Prepares administrative files for Medical Directors, UM Nurses and Case Managers
- Performs daily Inpatient Census Reconciliation
- Monitors UM inventory to ensure adherence to CMS regulations
- Participates in meetings as needed for clerical support
- Maintains knowledge of benefits, network, CMS regulations and policies
- 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 NW PKWY / M – F: 9AM – 6PM (8HRS) / Rotating - Sat. – Sun.: 8AM – 5PM.
- High School Diploma or GED
- 6 months or more previous related experience in healthcare, call center, and/or customer service
- Familiarity with ICD-9/ICD-10 coding
- Proficiency with Microsoft Office applications
- Associate's Degree in a healthcare related field
- 1 or more years previous related experience in healthcare, call center, and/or customer service
- One or more years managed care experience in Prior Authorization or Claim Review
- Knowledge of Medical Terminology preferred.
Ready to answer the call? Take this opportunity to do your life's best work.(sm)
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 240,000+ 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