Job Description

**Opportunities at WellMed,** part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind **Caring. Connecting. Growing together.** This position is full time, Sunday - Wednesday. Employees are required to have flexibility to work any of our 10-hour shift schedules during our normal business hours of 7:00am - 6:00pm CST. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of paid training. The hours during training will be 8:00am to 5:00pm CST, Monday - Friday. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. **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 + 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 to the UM policy + Receives appeal requests from health plans and/ or QIO, logs request, 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 + Must be able to work a flexible schedule that includes evening hours and holidays. In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone. 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 + Must be 18 years of age OR older + 2+ years of working remote in data entry experience + Knowledge of medical terminology + Proficient software computer skills + Ability to work full time, Sunday - Wednesday. Employees are required to have flexibility to work any of our 10-hour shift schedules during our normal business hours of 7:00am - 6:00pm CST. It may be necessary, given the business need, to work occasional overtime. **Preferred Qualifications:** + Experience in healthcare + Telephonic and/or telecommute experience + Familiarity with ICD-9 coding + Verbal and written skills + Ability to do 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 do customer service with patients, providers, and health plan and interacting with other internal departments within the organization **Telecommuting Requirements:** + 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. *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy   The hourly range for this role is $16.88 to $33.22 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. **_Application Deadline_** _: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants._ _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._ _OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._ \#RPO

Job Tags

Hourly pay, Minimum wage, Full time, Work experience placement, Local area, Remote work, Live in, Flexible hours, Shift work, Sunday, Afternoon shift, Monday to Friday,

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