1+ months

Utilization Management Coordinator Healthcare WellMed San Antonio TX - 890392

San Antonio, TX 78205
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  • Job Code
    890392

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 achieveyour life's best work.(sm)

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TheAssociate"Patient Care Coordinatorprovides 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.

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Primary Responsibilities:

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  • Provides data entry, filing," tracking time frames and status of case files and mailing letters to" patients and providers.
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  • Reviews denials and determines" whether the decisions are retro/ claims DOS or prospective DOS, and" whether they are NCB or medically necessary. Sorts appropriately.
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  • Monitors system approval queues" and prints member letters, ensuring that all approvals are printed and" mailed by end of business day.
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  • Prepares envelopes and letters" for mailing according the UM policy.
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  • Receives appeal requests from" health plans and/ or QIO, logs requests, researches and provides requested" information.
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  • Works with claims department to" redirect claims related appeal requests.
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  • Generates reports for analysis" by department using the data entry system.
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  • Assists with CMS organization" determination reports as needed
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This is an office based"position located at our office off of Northwest Parkway in San Antonio, TX. The"position requires working various shifts including evenings, weekends and"holidays as determined by the business.

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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.

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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:

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  • High School diploma or GED
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  • 2+years of related" experience
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  • Sound knowledge of medical" terminology
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  • Proficient software computer" skills
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  • Possess planning, organizing," conflict resolution, negotiation and interpersonal skills
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  • Independent problem" identification / resolution and decision making skills
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  • Ability to interact with" individuals and with multidisciplinary teams
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  • Ability to demonstrate excellent" customer service with patients, providers, and health plan and interacting" with other internal departments within the organization
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Preferred"Qualifications:

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  • Previous related experience in" healthcare
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  • Familiarity with ICD - 9 coding
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  • Excellent verbal and written" skills
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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 impacting550,000+ 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 doyour life's best"work.(sm)

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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.

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

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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, 75249, NW PKWY., Texas,"TX


Posted: 2020-09-17 Expires: 2020-12-26

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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Utilization Management Coordinator Healthcare WellMed San Antonio TX - 890392

UnitedHealth Group
San Antonio, TX 78205

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