WellMed, part of the Optum family of businesses, is seeking a Clinical Administrative Coordinator to join our team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.
At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
Under the supervision of the Medical Claims Review (MCR) Supervisor, this position is responsible for processing targeted projects of Utilization Management (UM) Inventory. Assc MCR Coordinator is responsible for coordinating processes with MCR UM Coordinators and UM Nurses as needed. MCR Assc Coordinator is responsible for providing clerical support to
WellMed clinical staff for their medical necessity review process. Assc MCR Coordinator is expected to maintain production and quality standards.
This position is part-time, Monday - Friday. Employees are required to have flexibility to work any of our 5-hour shift schedules during our normal business hours of 7:00am - 3:00pm. It may be necessary, given the business need, to work occasional overtime.
We offer 2-3 weeks of paid training. The hours of training will be based on your schedule or will be discussed on your first day of employment.
If you are located in San Antonio, TX, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities - Research and resolve targeted UM inventory accordingly to meet productivity and quality standards to include:
- Claims reports with reconciliation needs
- Information received through Right Fax
- Information received through email
- Or any other methods of receipt (phone calls, etc.)
- Coordinates initial screening for UM claim reviews through claim queue
- Prepares administrative files for MCR Coords, Medical Directors and MCR Nurses
- Documents and follows-up on all assigned inventory, utilizing on-line systems and procedures, according to established guidelines
- Maintains knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
- Utilize experience and judgement to plan, accomplish goals and effectively resolve each assigned task
- Performs all other related 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 / GED
- Must be 18 years of age OR older
- 1+ years of managed care experience in Prior Authorization OR Claims Review
- Familiarity with Microsoft Office applications (i.e. Microsoft Excel, Microsoft Access)
- Must live within 30 miles of San Antonio, TX
- Ability to work in a Part-Time Role
- Ability to work Monday - Friday, in any of our 5-hour shift schedules during our normal business hours of 7:00am - 3:00pm
Preferred Qualifications
- Knowledge of Medical Terminology
- ICD-9/ICD-10 and CPT knowledge
Telecommuting Requirements
- Reside within a commutable distance to the office at 19500 W Interstate, San Antonio, TX
- Ability to keep all company sensitive documents secure (if applicable)
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Soft Skills
- Ability to organize, prioritize and communicate effectively
- Ability to provide excellent customer service to a varied customer base
- Ability to navigate multiple systems
- Ability to work in a fast-paced environment
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
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