Job Description

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 Medical Management Performance 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 for appropriate data entry and verify accuracy of standard letter templates.

If you are located in San Antonio, TX, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

* Provides data entry, and verifies regulatory letter requirements
* Monitors tracking time frames and case file status, compiling records, auditing letters and correspondence, and preparing charts for health plan audits.
* Generates reports for analysis by department using the data entry system
* Assists with CMS organization determination reports as needed

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 clerical or Administrative experience
* Sound knowledge of medical terminology
* Proficient software computer skills (Microsoft Excel, including pivot tables and formulas)
* 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 internal customers with health plan requests
* Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

* Previous related experience in healthcare
* Familiarity with ICD-9 / ICD-10 coding
* Excellent verbal and written skills
* Prior experience with SharePoint, TruCare, Interqual and MS Project software

Physical and Mental Requirements:

* Ability to lift up to 25 pounds
* 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., WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for 550,000+ older adults with over 16,000 doctors' offices 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: Utilization Management Coordinator, Denials, Claim Review, Regulatory, Excel, CMS, Medicare, San Antonio, TX