13 days old

Eligibility Specialist - San Antonio, TX - 933164

San Antonio, TX 78205
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  • Job Code
    933164

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 lifes best work.(sm)

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The Eligibility Specialist is responsible for analyzing and maintaining member eligibility within the IKA Member Module. This position reviews and audits member eligibility for accuracy and completeness. Position also partners with internal and external customers to assist with resolving member eligibility issues, as well as root cause analysis.

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Primary Responsibilities:

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  • Perform data and root cause analysis of business / systems processes related to WellMed supported member eligibility
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  • Assist the various enterprise departments by providing support with regard to any WellMed supported eligibility verifications or issues
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  • Work with Systems Specialist to load EDI eligibility data received from payers into system
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  • Identify, research, and resolve eligibility discrepancies via the reconciliation process
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  • Identify and report reoccurring eligibility discrepancy trends to Systems Specialists and leadership
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  • Research and resolve downstream reporting issues caused by eligibility or provider configuration
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  • Collaborate with other departments to resolve upstream configuration issues affecting eligibility
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  • Maintain general knowledge of all payer eligibility systems and processes to ensure appropriate research and accurate responses to eligibility inquiries
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  • Perform all other related duties as assigned
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Youll 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.

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Required Qualifications:

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  • High School Diploma or GED
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  • 2+ years of experience in a healthcare environment
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  • Intermediate Excel knowledge
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  • Strong analytical skills
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  • Excellent organizational skills and attention to detail
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  • Proficient verbal and written communication skills
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  • Proficient computer literacy skills
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  • Office base position in San Antonio, Monday-Friday working standard business hours
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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  • Bachelors degree in Business, Healthcare or related field
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  • 3+ years of experience in a healthcare environment
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  • 2+ years of managed care eligibility experience
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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)

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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.

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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.

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OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Eligibility Specialist, San Antonio, TX, Texas

Posted: 2021-06-10 Expires: 2021-07-10

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Eligibility Specialist - San Antonio, TX - 933164

UnitedHealth Group
San Antonio, TX 78205

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