Utilization Management Coordinator Healthcare WellMed San Antonio TX

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)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.Primary Responsibilities:

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 business day.

Prepares envelopes and letters for mailing according the UM policy.

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 requests.

Generates reports for analysis by department using the data entry system.

Assists with CMS organization determination reports as needed

This is an office based position located at our office off of Northwest Parkway in San Antonio, TX. The position requires working various shifts including evenings, weekends and holidays as determined by the business.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.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 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 making skills

Ability to interact with individuals and with multidisciplinary teams

Ability to demonstrate excellent customer service with patients, providers, and health plan and interacting with other internal departments within the organization

Preferred Qualifications:

Previous related experience in healthcare

Familiarity with ICD - 9 coding

Excellent verbal and written skills

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 350,000+ 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)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, 75249, NW PKWY., Texas, TX