Senior Clinical Administrative Coordinator – San Antonio, TX

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

This position is full time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am – 4:00 pm. It may be necessary, given the business need, to work occasional overtime. Employees are required to work 3 days onsite and 2 days from home.

We offer 2-3 weeks of on-the-job training. The hours of the training will be aligned with your schedule.

 

Primary Responsibilities: 

• Review claims for duplicates, denials and referrals and ensures that claims information is matched to appropriate authorization
• Prepares cases for Medical Directors, UM Nurses and Case Managers to conduct clinical review
• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
• Provide guidance and act as a resource to trainers and new hires on benefits, contract interpretations, exclusions, eligibility, policies, standard operating procedures, job aids and workflows to other MCR Coordinators in resolving complex issues
• Assist with escalated issues, and provide guidance as assigned and maintain prompt turnaround time on all claims and handle priority claims within 24 hours
• Meet department quality and accuracy standards
• Interface with other departments to obtain necessary information required for resolution of claims
• Take ownership of the total work process and provide constructive information to minimize problems and increase customer satisfaction
•  Ensure documentation is completed in appropriate systems
• Prepare and monitor MCR inventory reports to ensure adherence to turnaround time requirements designated in contracts and/or relevant regulations
• Effectively communicate with all Supervisors and Directors
• Performs all other related duties as assigned

 

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we’re making health care work better for everyone.

 

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
• 18 years of age OR older
• 2+ years of related managed care experience in Prior Authorization or Claim Review healthcare, and/or customer service
• 1+ years in the healthcare industry
• Knowledge of medical terminology, ICD-10 and CPT knowledge
• Proficiency with Microsoft Office applications
• Proficient with Medicare processing guidelines, working knowledge of medical contracts
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00 am – 4:00 pm. It may be necessary, given the business need, to work occasional overtime. Employees are required to work 3 days onsite and 2 days from home.

 

Telecommuting Requirements: 

• Reside within commutable distance to the office at 19500 W Interstate 10. San Antonio, TX 78257
• 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 

 

The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

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

 

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