Job Description

Associate Patient Care Coordinator - Keller, TX at Optum summary:

The Associate Patient Care Coordinator at Optum provides direct support to patients by responding to inquiries, scheduling appointments, and facilitating communication between patients, providers, and external resources. This role manages patient data, insurance verifications, and coordinates non-episodic case management to improve healthcare outcomes. The position emphasizes patient advocacy, understanding of healthcare regulations, and collaboration with multidisciplinary teams to ensure quality care delivery.

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Schedule : Monday to Friday, 8:30 AM – 5:30 PM

Location : Onsite - 1110 Keller Pkwy, Keller, TX 76248

Primary Responsibilities:

• Respond to patient questions in person or over the phone
• Greet patients and build rapport to provide a positive patient experience
• Collect patient payments
• Make patient follow up calls (e.g., after procedures, admissions, or ER visits) to identify/close gaps in care
• Ask patients for and/or assist patients with completing required paperwork (e.g., health history, insurance documentation, etc.
• Connect patients with outside resources (e.g., community resources, social services) to promote self-care
• Review and support implementation of patient plan of care
• Work directly with patients to identify specific needs and/or request adjustments to plan of care
• Coordinate services/case management for non-episodic and non-catastrophic cases
• Manage/respond constructively to challenging patient interactions (e.g., address lack of understanding, socioeconomic challenges, frustrated patients, language barriers)
• Explain and talk to patients or caregivers about sensitive health care decisions such as advanced directives, physician's order for life sustaining treatment, and palliative care/hospice referrals
• Explain and ensure understanding of details related to patient care (e.g. home health care transition procedures)
• Explain medical benefits/coverage specifics (e.g., procedures/amounts covered, denials of coverage, appeal rights
• Access insurance plan systems to verify insurance eligibility/benefits for patients and seek additional information as necessary
• Input/update patient demographic data into computer system
• Update/upload patient care data (e.g., care plan data, inpatient data, patient program flags) in computer systems
• Document patient interactions in appropriate systems/logs (e.g., medication changes)
• Enter/process patient referral data (e.g., medical services, radiology, durable medical equipment)
• Generate reports on patient data through relevant computer systems/applications
• Review/analyze patient data reports (e.g., discharges, hospital admissions/readmissions, skilled nursing facilities) and follow up as necessary
• Identify inconsistencies in diagnosis/procedure codes and update codes in the system
• Enter patient payments, prepare deposits, and balance daily deposit log/ledger
• Draft/provide written communications to patients (e.g., standard letters, welcome letters, educational materials) in compliance with company and health plan guidelines
• Maintains patient/staff data and generates aggregate data report
• Verify referral approval prior to scheduling appointments
• Schedule patients for walk-in or future appointments
• Ensure provider templates/procedures are built correctly to schedule appointments in appropriate time slots
• Ask patient questions to verify patient data or needs for scheduling
• Coordinate/confirm scheduling of doctor visits/services with patients
• Make calls to doctor's office on patient's behalf to schedule, check progress, and facilitate the care process
• Identify resources available to support patient care (e.g., housing, social services, meals)
• Work with durable medical equipment providers/obtain durable medical equipment for patients
• Manage patient referral process (e.g., review for duplicates, ensure referral is sent to appropriate provider, follow-up with requesting provider to recommend changes)
• Engage physician to obtain or provide information related to patient care (e.g., modifying authorizations, redirecting care, clarifying orders/notes)
• Maintain open communication and rapport with physicians to promote patient services/care
• Ensures patient scheduling/follow up activities are completed according to federal, state, or organizational guidelines (e.g., referral guidelines, follow up notifications, PCP follow up)
• Screens/forwards incoming calls from patients, physicians, and health plan
• Demonstrate understanding of relevant health plan guidelines and benefits (e.g., Medicare, Medicaid/Medical, commercial benefit plans, Federal/local government regulations)
• Demonstrate understanding of Federal privacy regulations (e.g., HIPAA)
• Demonstrate knowledge of safety guidelines/practices (e.g., OSHA)
• Demonstrate knowledge of basic medical terminology and human anatomy to document patient information using standard language/medical terminology
• Apply understanding of evidence-based practice guidelines (e.g., Millliman) to evaluate medical necessity of procedures
• Demonstrate understanding of managed care policies/procedures that apply to patient care
• Demonstrate understanding of managed care practices/contract provisions to evaluate appropriateness of services (e.g., contracted providers, financial implications, relevant regulations)
• Other duties as assigned

Required Qualifications:

• High School Diploma/GED (or higher)

Preferred Qualifications:

• Experience working in a front desk for a clinic

The salary range for this role is $16.00 to $28.85 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.

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.

UnitedHealth Group 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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #RED

Keywords:

patient care coordination, healthcare scheduling, medical billing, insurance verification, case management, patient advocacy, health information management, medical terminology, HIPAA compliance, care plan coordination

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