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 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.
This is a fast call center environment that requires answering calls and data entry. This position requires working various shift hours and rotating / required weekend.
The Care Team Associate (CTA) for prior authorization department will effectively support the successful implementation and execution of all Utilization Management programs and processes. The Care Team Associate will provide support to the Utilization Management staff to ensure applicable program processes and operational responsibilities are met. The CTA will prepare the authorization by seeking out medical records to the providers via phone or fax, and once completed it is sent to the nurse for review. This position will also provide support in troubleshooting any authorization related issues identified by the Medical Management staff. This position will also assist with training and orientation of new staff and will serve as a subject matter expert for existing staff to ask questions.
If you are located in TX area, you will have the 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 providing complete and accurate information to 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
- Adheres to assigned schedule and quality metrics
- Provides clerical and / or administrative support to clinical staff and managers for special studies, projects and reports
- Provides excellent customer service by serving as a resource to all internal and external customers
- Attends required meetings and participates in special committees as needed
- Assists with training and onboarding of Utilization Management Care Team Associates
- May act as a team lead for projects and departmental initiatives as assigned
- Performs other duties as assigned
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 administrative support experience
- Possesses medical terminology knowledge base
- General knowledge of CPT, and ICD-10
- Working knowledge of Microsoft Office, Internet and e-mail
- Certified Medical Assistant training or certification
- 2+ years of experience with prior authorization or claims
- Able to work independently, with some supervision and direction from manager
- 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
- 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
- Comply with all organizational policies regarding ethical business practices
- Adhere to all department policies and procedures
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
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.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.