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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)WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.The Sr. Clinical Admin Coordinator for prior authorization department will effectively support the successful implementation and execution of all Utilization Management programs and processes. The Sr. Admin Coordinator provides support to the Utilization Management staff to ensure applicable program processes and operational responsibilities are met. This position includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring providers as appropriate to clinical staff. Sr. CAC manages the processes of incoming and outgoing medical record requests, and prior authorizations. This function includes intake, notification and census roles. The Sr. CAC will prepare prior authorization requests for clinical review and will complete prior authorization requests as per policy and procedure. This position will also provide support in troubleshooting any authorization related issues identified by the Medical Management staff.Primary Responsibilities:
Receives and responds to inquiries from all communication venues: e.g. phone, queue, department e-mail box or fax
Coordinates and assists initial screening of prior authorization requests via all communication venues; as well as administrative preparation for clinical staff
Exhibits excellent phone and communication skills while serving as a resource to all internal and external customers
Requests additional or supplemental information via correspondence in order to complete prior authorization requests
Completes prior authorizations in the WellMed prior authorization system according to approved policies and procedures
Compiles and reports data for ongoing key performance indicators and summarizes and presents findings to departmental leadership. Notifies manager of trends they observe
Provides clerical and/or administrative support to clinical staff and managers for special studies, projects and reports
Attends required meetings and participates in special committees as needed
Assists with training and onboarding of Utilization Management Care Team Associates
Sometimes acts as a technical resource to others in own function
Perform routine tasks required of all PA team members, including: Accessing electronic member files using policy or id number, determining member eligibility, extracting and reviewing fax requests for medical or clinical services, receiving electronic
referral form requests for medical/clinical services, following protocols to task requests appropriately, determining whether authorizations are required for requested medical services
Check procedure codes against notification requirements and benefit coverage to determine next steps in prior authorization process
Reference automated job aid tools via the computer to identify appropriate procedures when needed
Ask callers standard questions to understand requests, gather necessary information, and assess urgency
May coordinate work of other team members
Performs all other related duties as assigned
This is an office based position located off of Northwest
Parkway in San Antonio, TX. This is a fast call center environment that
requires answering calls and data entry. This position requires working various
shift hours and rotating/required weekendsYou’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 or GED
Four or more years of experience in a medical or pharmacy setting
Two or more years of administrative support experience
Applies knowledge/skills to a range of moderately complex activities
Demonstrates great depth of knowledge/skills in own function and works independently
Proactively identifies solutions to non-standard requests
Solves moderately complex problems on own
Works with team to solve complex problems
Plans, prioritizes, organizes and completes work to meet established objectives
Possesses medical terminology knowledge base
General knowledge of CPT, and ICD-10
Must possess and demonstrate excellent organizational skills, customer service skills, and verbal and written communication skills to include but not limited to patients, physicians, clinical staff, contracted providers and managers
Working knowledge of Microsoft Office, Internet and e-mail
Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times
Must maintain strict confidentiality at all times to include but limited to patients and coworkers
Must adhere to all department policies and procedures
Preferred Qualifications:
Certified Medical Assistant training or certification
Two or more years of experience with prior authorization or claims
Knowledge of Medicare guidelines
Physical & Mental Requirements:
Ability to lift up to 10 pounds
Ability to sit 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 350,000+ 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, Prior Authorization, Utilization Management, Pharmacy Medical terminology, ICD and CPT, Claims Coder, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, 75249, NW PKWY., Texas, TX
Vacancy expired!