US Remote
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 (40hours/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 two days onsite and three days from home.
We offer 3-4 weeks of training. The hours during training will be 7:00 am to 4:00 pm, Monday – Friday
If you are within commutable distance to the office at 19500 W. Interstate 10, San Antonio, TX 78257, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.
Primary Responsibilities:
- Research and resolve 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 Medical Directors, UM Nurses and Case Managers
- Contacts provider offices to obtain clinical information for medical review by a clinician to meet Center for Medicare and Medicaid Services (CMS), state and health plan guidelines/regulations.
- 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
- Receives and responds to telephone calls through the UM Phone Queue, as needed
- 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 or older
- 2+ years managed care experience in Prior Authorization or Claim Review
- 6+ months experience using Medical Terminology, ICD-9/ICD-10 and CPT
- 6+ months experience working in an environment that is based on meeting metrics and daily goals (example – handling 40 cases per day)
- Proficiency with Microsoft Office applications (examples -Microsoft Outlook, Microsoft Access, Microsoft Word, Microsoft Excel)
- Ability to work onsite at 19500 W. Interstate 10, San Antonio, TX 78257 three days a week and from home two days a week after training and ramp up period3
- 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.
Preferred Qualifications:
- Proficient with Medicare processing guidelines, working knowledge of medical contracts
Telecommuting Requirements:
- Reside within commutable distance to the office at 9500 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:
- Exceptional ability to organize, prioritize and communicate effectively.
- 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 $16.88 to $33.22 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.
