Combine two of the fastest-growing fields on the planet with a
culture of performance, collaboration and opportunity and this is
what you get. Leading edge technology in an industry that's
improving the lives of millions. Here, innovation isn't about
another gadget, it's about making health care data available
wherever and whenever people need it, safely and reliably. There's
no room for error. Join us and start doing your life's best
WellMed provides concierge - level medical care and service for
seniors, delivered by physicians and clinic stat that understands
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 Associate Patient Care Coordinator provides 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.
- Provides data entry, filing, tracking time frames and status of
case files and mailing letters to patients and providers.
- Reviews denials and determines whether the decisions are retro/
claims DOS or prospective DOS, and whether they are NCB or
medically necessary. Sorts appropriately.
- Monitors system approval queues and prints member letters,
ensuring that all approvals are printed and mailed by end of
- Prepares envelopes and letters for mailing according the UM
- Receives appeal requests from health plans and/ or QIO, logs
requests, researches and provides requested information.
- Works with claims department to redirect claims related appeal
- Generates reports for analysis by department using the data
- Assists with CMS organization determination reports as
- 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.
If you are located within commutable distance from WellMed
office, you will have the flexibility to telecommute* as you take
on some tough challenges.
The position requires working various shifts including evenings,
weekends and holidays as determined by the business.
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.
- High school diploma or GED
- 2+ years of related experience
- Sound knowledge of medical terminology
- Proficient software computer skills
- Possess planning, organizing, conflict resolution, negotiation
and interpersonal skills
- Independent problem identification / resolution and decision
- Ability to interact with individuals and with multidisciplinary
- Ability to demonstrate excellent customer service with
patients, providers, and health plan and interacting with other
internal departments within the organization
- If you need to enter a work site for any reason, you will be
required to screen for symptoms using the ProtectWell mobile app,
Interactive Voice Response (i.e., entering your symptoms via phone
system) or similar UnitedHealth Group-approved symptom screener.
When in a UnitedHealth Group building, employees are required to
wear a mask in common areas. In addition, employees must comply
with any state and local masking orders
- Related experience in healthcare
- Familiarity with ICD - 9 coding
- Excellent verbal and written skills
- Telephonic and/or telecommute experience
Careers with Optum. Here's the idea. We built an entire
organization around one giant objective; make the health system
work better for everyone. So when it comes to how we use the
world's large accumulation of health-related information, or guide
health and lifestyle choices or manage pharmacy benefits for
millions, our first goal is to leap beyond the status quo and
uncover new ways to serve. Optum, part of the UnitedHealth Group
family of businesses, brings together some of the greatest minds
and most advanced ideas on where health care has to go in order to
reach its fullest potential. For you, that means working on high
performance teams against sophisticated challenges that matter.
Optum, incredible ideas in one incredible company and a singular
opportunity to do your life's best work.(sm)
Colorado Residents Only: The hourly range for Colorado residents
is $15.00 to $25.19. Pay is based on several factors including but
not limited to education, work experience, certifications, etc. As
of the date of this posting, In addition to your salary, UHG offers
the following benefits for this position, subject to applicable
eligibility requirements: Health, dental, and vision plans;
wellness program; flexible spending accounts; paid parking or
public transportation costs; 401(k) retirement plan; employee stock
purchase plan; life insurance, short-term disability insurance, and
long-term disability insurance; business travel accident insurance;
Employee Assistance Program; PTO; and employee-paid critical
illness and accident insurance.
*All Telecommuters will be required to adhere to UnitedHealth
Group's Telecommuter Policy.
For more information on our Internal Job Posting Policy, click
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, Supervisor,
Utilization Management, UM, Medical terminology, ICD and CPT,
Claims Coder, San Antonio, New Braunfels, Seguin, Gonzales, Shiner,
Yoakum, Boerne, Floresville, Helotes, Texas, TX