- Documents all patient interactions in a concise manner that is compliant with documentation requirements for Model of Care, NCQA and Center for Medicare and Medicaid Services (CMS) regulations.
- Receives and responds to incoming Care Coordination inquiries from all communication venues: e.g. phone queue, TruCare, portal, claim queue, department e-mail box or Rightfax.
- Coordinates and assists in monitoring of documentation Care Management queues for Concurrent, Complex Care, and Social Work referrals, CTA processes UM requests via all communication venues, as well as administrative preparation for clinical staff.
- Conducts in-bound and out-bound calls for program requirements including, but not limited to: patient scheduling, surveys/screenings, census management and distribution of materials to appropriate clinical personnel or members.
- Performs daily preparation of Inpatient Census to include monitoring of UM expedited, standard, concurrent in-patient cases in "pend" and informs Care Management Manager of outstanding cases to ensure adherence to CMS regulations.
- Participates in market
- Schedules and coordinates patient transportation, follow-up physician appointments in all applicable markets, as applicable.
- Completes timely data entry of in-bound and/or out-bound call member contact information into software applications (Claims Database, TruCare, etc.).
- Provides clerical and/or administrative support to clinical staff and managers for special projects and reporting needs.
- Provides excellent customer service by serving as a resource to all internal and external customers.
- Attends required meetings and participates in adhoc committees as needed.
- Maintains knowledge of all health plan benefits, network, CMS, regulations, health plan policies.
- Maintains monthly logs for Notice of Medicare Non-Coverage (NOMNC) per delegation requirements and distributes to management. Performs all other duties as assigned.
- High School Diploma / GED
- 2 years of administrative support experience.
- Advanced knowledge of Microsoft Office products, including Microsoft Excel, Microsoft Word, and Microsoft Outlook.
- Medical terminology knowledge.
- Must be in commutable distance to Mc
- Must be 18 years of age OR older
- Ability to work full-time, Monday - Friday between 8:00am - 5:00pm including the flexibility to work occasional overtime given the business need
- 2 years of experience in a physician's clinic or hospital
- 3 years of experience working in a medical care setting as a receptionist or medical assistant
- Bilingual language proficiency in English / Spanish
- Certified Medical Assistant training or certification
- Must possess and demonstrate excellent organizational skills, customer service skills, to include verbal and written communication.
- Must maintain and demonstrate a high degree of professionalism.
- Must maintain strict confidentiality at all times.
- Must adhere to all department/ organizational policies and procedures.
- Must be able to work independently, with some supervision and direction from manager.
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Clinical Administrative Coordinator - Harlingen, United States - UnitedHealth Group
Description
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
This position is full-time (40 hours/week)
Monday - Friday, 8:00am - 5:00pm. All training is completed onsite.
Our offices are located at Mc
Allen Market Office:
3300 N. McColl Rd.
McAllen, Texas 78501 or Harlingen Market Office: 3809 West Business 83 Harlingen, Texas 78552
We offer 4 weeks of paid training. The hours during training will be 8:00am - 5:00pm, Monday - Friday.
Training will be conducted onsite.
Primary Responsibilities:
Patient Care Committees:
prepares agenda, documents minutes and distributes to appropriate venue
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:
Allen Market Office: 3300 N. McColl Rd.
McAllen, Texas 78501 or Harlingen Market Office: 3809 West Business 83 Harlingen, Texas 78552.
Preferred Qualifications:
Soft Skills:
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
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._
\#RPO #RED
