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)
This high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our providers and members over the phone and managing fax. You also must be able to work a flexible schedule that includes evening hours and rotating weekends.
This position is responsible for the daily coordination of the administrative intake of members in the Intake Call Center. This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our providers and members over the phone. You also must be able to work a flexible schedule that includes evening hours.
- Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
- Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and / or providers
- Assist the clinical staff with setting up documents / triage cases for Clinical Coverage Review
- Provide excellent customer service, including the ability to handle escalated callers
- Handle resolution / inquiries from members and/or providers
- Provide administrative approvals (depends on line of business)
- Handling expedited authorizations, authorization updates and status checks
- Responsible for outreaches to providers and / or patient to complete authorization requests and prescriptions
- Maintain knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
- Perform all other related duties as assigned
This is a call center environment near Lockhill Selma Rd. / De Zavala / IH - 10 / Loop 1604, San Antonio, TX, 78249, Mon - Fri: 7AM - 6PM (11HRS) / Required Rotating Sat - Sun: 8AM - 5PM.
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 equivalent
- 2+ years of experience in telephone customer service
- Experience with MS Office software including Outlook, Word and Excel
- 1+ years of experience working in an inbound customer service call center and with healthcare insurance
- Experience working in the medical environment with an aptitude of medical terminology
- A clerical or administrative support background
- Knowledge of ICD-9 and CPT codes
- Bilingual English and Spanish
- Strong oral and written communication with exceptional soft skills
- Ability to source information rapidly in an electronic environment
- High sense of attention to detail
Physical & Mental Requirements:
- 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 550,000+ 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
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Clinical Administrative Coordinator, call center, San Antonio, TX, Texas