For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Business Services department is seeking a Business Services Representative I to join their team full time.
The Insurance Follow Up Representative serves the patients, clinicians, and staff of Optum by obtaining payment on outstanding receivables timely. Focus is upon resolving any issues that may be causing delay of payment, including contacting payers and using appropriate websites to determine claim status. Investigation and resolution of denied claims including identification of trends and payer behavior that is contributing to inaccurate or delayed reimbursement for services rendered by our providers. Primary function is to overcome obstacles to ensure timely and accurate insurance payment, validation that insurance liability has been met prior to assigning patient liability. Research and identification of clinic and payer behavior and trends that may risk reimbursement, addressing those scenarios to mitigate unnecessary write offs/ losses. Independently works directly with straight forward payer contracts and guidelines to obtain accurate payment of insurance claims. Easily resolving eligibility denials but needing increased support to resolve billing related denials.
Performs follow up actions including correcting payer rejections, checking claim status, updating patient registration related items, and rebilling claims as necessary to ensure claims are processing in a timely fashion; escalate issues as appropriate to leadership
Schedule: 40 hours a week. Monday-Friday 7:00am-3:30pm (PST); schedule may vary depending on team and training.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Contacts insurance carriers/patients regarding outstanding insurance claims to obtain proper payment based on EOB and/ or Experian contract modeling expectations
- Knowledge of clinic operating policies to help in the identification of denial root causes
- Prepares proper documentation for appeals to insurance carriers
- Processes the appealing of claims reimbursed incorrectly by payors
- Ensures all accounts are set-up correctly in the computer using knowledge of A/R software, understanding of eligibility requirements and use of the internet and payer portals
- Has thorough knowledge of insurance carrier procedures and processes
- Understands contract reimbursement rates for individual carriers/networks
- Able to examine documents for accuracy and completeness including preparing records in accordance with detailed instructions
- Must meet minimum production and quality standards as set by management
- Responsible for managing their assigned worklist and following standard work to take actions to resolve no response claims, understand and respond to denied claims and effectively minimize over 90 aged claims and preventable adjustments
- Able to examine documents for accuracy and completeness including preparing records in accordance with detailed instructions
- Maintains Over 90 aging quality measures as determined by payer baselines and expectation
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 or equivalent experience
- 1+ years of medical insurance billing and claims follow up (multi-specialty clinic and/or payer experience an asset)
- Proven working knowledge of CPT & diagnosis coding, medical terminology, and basic anatomy
- Proven knowledge of insurance (plans, processes, requirements)
- Demonstrable computer aptitude
Preferred Qualifications:
- CPC Certification
- Multi-specialty clinic experience
- Customer service or billing experience
- Good Computer skills, minimum typing skill of 40 wpm
- Solid interpersonal and team skills
- Ability to work effectively to meet deadlines and assist others to do the same
- Competent in written and verbal communication
- Demonstrated ability to work effectively with staff, patients, community, and external agencies
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $16.00 to $28.27 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.