Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
This position is responsible for processing Utilization Management (UM) Inventory. MCR Coordinator is responsible for handling customer service or provider calls as needed. Coordinates UM processes with WellMed Medical Directors, UM Nurses, hospitals, physicians and other various departments. MCR Coordinator is responsible for providing clerical support to WellMed clinical staff for their medical necessity review process. MCR Coordinator is expected to maintain production and quality standards.
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This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 4:00 pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 19500 W INTERSTATE, San Antonio, TX
We offer 3 - 4 weeks of training. The hours during training will be 7:00 am to 4:00 pm, Monday - Friday.
Primary Responsibilities:
- Research and resolve UM inventory accordingly to meet productivity and quality standards to include:
o Claims reports with reconciliation needs
o Information received through Right Fax
o Information received through email
o Or any other methods of receipt (phone calls, etc.)
- Coordinates initial screening for UM claim reviews through claim queue
- Prepares administrative files for Medical Directors, UM Nurses and Case Managers
- Contacts provider offices to obtain clinical information for medical review by a clinician to meet Center for Medicare and Medicaid Services (CMS), state and health plan guidelines/regulations.
- Documents and follows-up on all assigned inventory, utilizing on-line systems and procedures, according to established guidelines
- Maintains knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
- Utilize experience and judgement to plan, accomplish goals and effectively resolve each assigned task
- Receives and responds to telephone calls through the UM Phone Queue, as needed
- Performs all other related 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.
Required Qualifications:
- High School Diploma/ GED
- 18 years or older
- 2+ years managed care experience in Prior Authorization or Claim Review
- 6+ months experience using Medical Terminology, ICD-9/ICD-10 and CPT
- 6+ months experience working in an environment that is based on meeting metrics and daily goals (example - handling 40 cases per day)
- Proficiency with Microsoft Office applications (examples - Microsoft outlook, Microsoft access, Microsoft word, Microsoft excel)
- Ability to work onsite at 19500 W INTERSTATE, San Antonio, TX
- Ability to work any of our 8-hour shift schedules during our normal business hours Monday to Friday from 7:00 am to 4:00 pm. It may be necessary, given the business need, to work occasional overtime
Preferred Qualifications:
- Proficient with Medicare processing guidelines, working knowledge of medical contracts
Soft Skills:
- Exceptional ability to organize, prioritize and communicate effectively.
- Ability to navigate multiple systems
- Ability to work in a fast-paced environment
Telecommuting Requirements:
- Reside within commutable distance to the office at San Antonio, TX.
- Ability to keep all company sensitive documents secure (if applicable)
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
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.
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