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Medical Claims Review Coordinator, Healthcare, WellMed - San Antonio, TX

UnitedHealth Group


Location:
San Antonio, TX
Date:
11/17/2017
2017-11-172017-12-16
Job Code:
733783
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Job Details

733783 Medical Claims Review Coordinator Healthcare WellMed San Antonio TX

Medical Claims Review Coordinator, Healthcare, WellMed - San Antonio, TX (733783)

Position Description

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 life’s best work.(sm)  
 
The hours for this position are Monday - Friday 9am to 6pm.  There will be some occasional overtime as needed on Saturdays.
 
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 PHC Medical Directors, UM Nurses, hospitals, physicians and other various PHC departments. Provides clerical support to PHC 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 market Patient Care Committees as needed for clerical support
  • Maintains knowledge of PHC benefits, network, CMS regulations and PHC policies
  • Conducts provider education sessions on PHC UM processes
  • Non-clinical staff is not responsible for conducting any UM activity that requires interpretation of clinical information
  • Performs all other related duties as assigned
Required Qualifications:
  • High School Diploma or GED equivalent
  • 2 or more years of related experience
  • 1 or more years managed care experience in Prior Authorization or Claim Review
  • Medical Terminology, ICD-9 and CPT knowledge
  • Proficiency with Microsoft Office applications
Preferred Qualifications:
  • Medical Assistant (MA) certification
  • Associate’s Degree in a healthcare related field
Physical & Mental Requirements:
  • Ability to lift up to 25 pounds
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and / or machinery
  • Ability to receive and comprehend instructions verbally and / or in writing
  • Ability to use logical reasoning for simple and complex problem solving

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 90,000+ 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, Medical claims reviewer, Associate Patient Care Coordinator, Patient Services Rep, Patient Care Tech, Medical Office Specialist, Call Center, San Antonio, New Braunfels, Seguin, Gonzales, Boerne, 78249, NW Pkwy.

Job Details

  • Contest Number733783
  • Job TitleMedical Claims Review Coordinator, Healthcare, WellMed - San Antonio, TX
  • Job FamilyMedical and Clinical Operations
  • Business SegmentOptumCare

Job Location Information

  • San Antonio, TX
    United States
    North America
  • Other LocationsNEW BRAUNFELS, TX
    SEGUIN, TX
    Gonzales, TX
    Shiner-Texas, TX

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

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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