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.
If you are located in a Wellmed Location, you will have flexibility to telecommute* as you take on some tough challenges.
- 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 a fast call center environment that requires answering calls and data entry. This position requires working various shift hours and rotating/required weekends
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
- 4+ years of experience in a medical or pharmacy setting
- 2+ 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
- 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
- Maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times
- Maintain strict confidentiality at all times to include but limited to patients and coworkers
- Adhere to all department policies and procedures
- Certified Medical Assistant training or certification
- Two or more years of experience with prior authorization or claims
- Knowledge of Medicare guidelines
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
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)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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