The Systems Specialist is responsible for maintaining the system functionality of member eligibility within the IKA Member Module. This position reviews and audits member eligibility for accuracy, customizing entries as necessary based on rules for appropriate line of business. Position also partners with internal customers to assist with resolving member eligibility issues. Primary Responsibilities:Assists with performing data and root cause analysis of business / systems processes related to WellMed Member eligibilityCollaborate with management, compliance, and other departments to ensure accuracy of all member data and transactions for WellMed in a timely and effective mannerServes as the liaison with the system vendor for all items related to IKA Member Module and the 834 processEnsures system updates and revisions are promptly loaded in IKA Claims system to ensure optimal system performanceTests and reviews data to ensure that new or existing processes are appropriate based on business standardsProvides tier-one level of service and escalates identified issues to appropriate business unite owner and project team for support, guidance, and resolutionPerforms system testing and data validation when system integration efforts occur to ensure system changes integrate appropriatelyServes as a resource to other internal departments on Member Eligibility or IKA Member ModuleMaintains abreast of current Medicare guidelines, regulations and HMO compliance standards by reviewing all updates / bulletins and incorporating applicable industry changes into our systemsAssists with providing input related to system specification modifications and changes in regulation for lines of businessIdentifies, researches, and resolves eligibility discrepanciesEnsures Member Health Information and complaints are continuously maintained in a secure environment upon receipt and as the information is handled and processedPerforms all other related duties as assigned
Required Qualifications:High School Diploma or GED2+ years of experience within an information technology environment related to system dataAdvanced level skill in ExcelAdvanced level skill in Microsoft AccessIntermediate level skill in SQLOccasional travel may be required (<10%) Preferred Qualifications:2+ years of Managed Care experience2+ years of health systems integration experience4+ years of planning, testing, and reconciliation experienceExperience with MARx systemExceptional ability to organize and prioritizeExcellent verbal and written communication skills Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors 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: 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. Job Keywords: Systems Specialist, finance, information technology, SQL, San Antonio, TX, Texas
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.