In-take Coordinator / Healthcare Call Center Customer Service, WellMed - San Antonio TX
This high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our providers and members over the phone and managing fax. You also must be able to work a flexible schedule that includes evening hours and rotating weekends.
This position is responsible for the daily coordination of the administrative intake of members in the Intake Call Center. This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our providers and members over the phone. You also must be able to work a flexible schedule that includes evening hours.
- Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
- Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers
- Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
- Provide excellent customer service, including the ability to handle escalated callers
- Handle resolution/inquiries from members and/or providers
- Provide administrative approvals (depends on line of business) Handling expedited authorizations, authorization updates and status checks
- Responsible for outreaches to providers and/or Patient to complete authorization requests and prescriptions
- Maintain knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
- Perform all other related duties as assigned
This is a call center environment near Lockhill Selma Rd. / De Zavala / IH - 10 / Loop 1604, San Antonio, TX, 78249, Mon - Fri: 7AM - 6PM (11HRS) / Required Rotating Sat - Sun: 8AM - 5PM.
- 2 years of telephone customer service experience
- High School Diploma or GED equivalent
- Experience with MS Office software including Outlook, Word and Excel
- Strong oral and written communication with exceptional soft skills
- Ability to source information rapidly in an electronic environment
- High sense of attention to detail
- 1 year or more of experience working in an inbound customer service call center and with healthcare insurance.
- Experience working in the medical environment with an aptitude of medical terminology
- A clerical or administrative support background
- Knowledge of ICD-9 and CPT codes
- Bilingual English and Spanish
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)
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.
Job Keywords: CSR, Healthcare Customer Service Rep, medical terminology, Prior Authorization. Claim Review, San Antonio TX
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