Healthcare isn’t just changing. It’s growing more complex every day. ICD-10 Coding replaces ICD-9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that’s what fueled these exciting new opportunities.
Who are we? Optum360.
We’re a dynamic new partnership formed by Dignity Health and Optum to combine
our unique expertise. As part of the growing family of UnitedHealth Group, we’ll leverage our compassion, our talent, our
resources and experience to bring financial clarity and a full suite of Revenue
Management services to Healthcare Providers, nationwide.
If you’re looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.
- Ensure all claims are billed and received by the payers for proper adjudication. This includes timely processing of allocated volume of accounts, based on established production guidelines and time parameters provided for workflow.
- Responsible for outbound calls and / or status inquiries via payers website validating receipt of medical claims and adjudication status within established timeframes.
- Display competent ability to access, navigate, and manage account information through phone calls and payer websites.
- Work any edits and denials in allocated workflow to achieve proper adjudication to payment. This includes, but is not limited to: verify insurance is correct, update insurance demographics, rebill claims not received, document the status of work performed, follow-up on outstanding adjudication items according to departmental guidelines, and is also responsible for billing secondary / tertiary claims along with providing supporting documentation to payers for additional payment.
- Perform scheduled follow up on accounts to include calls to payers and/or patients, as well as accessing payer websites, and resolving complex accounts with minimal or no assistance necessary.
- Effectively resolve complex or aged inventory, including payment research and payment recoups with minimal or no assistance necessary.
- Document all work and calls performed, in accordance to policy. This includes complete contact information, good grammar, and expected outcomes.
- Obtain primary and / or secondary EOB and claims to bill next responsible payer, along with utilizing various internal resources to obtain medical records to respond to requests from payers upon request.
- Accurately and thoroughly documents the pertinent collection activity performed.
- Maintain assigned worklists and resolve high priority and aged inventory.
- Identify and communicate issues to leadership, including payer, system or escalated account issues for timely resolution.
- High School Diploma / GED (or higher)
- 2+ years of experience in Hospital Billing and / or Collections
- Ability to create, copy, edit, send, and save within Microsoft Word (creating and editing documents), Microsoft SharePoint (work within and navigate), and Microsoft Outlook (open and send emails and meeting requests)
- Experience and working knowledge of Microsoft Excel (create spreadsheets, pivot tables and formulas, data entry, reviewing reports, sort / filter and open / edit / saving documents)
- Experience in interpreting Payer Contracts and determining accurate payments on patient accounts
- Understanding of medical terminology, diagnosis codes, denial codes, ICD10 Codes and calculating fee schedules
- Strong understanding of UB’s and Remittance Advise (RA’s)
- Ability to read and understand EOB’s (Explanation of Benefits)
- Experience to know the appropriate questions to ask when calling Medicare to get the necessary information to move forward in resolving the claim
- Ability to have a solid understanding of hospital claims and processes in order to review and analyze claims and account receivable functions
- Able to identify trends when working claims and communicate this to their Supervisor timely for quick resolution
- Ability to “think outside the box” to recommend innovative solutions
- Highly motivated and able to work independently, comfortable with ambiguity
- Ability to remain focused and productive each day though tasks may be repetitive
- Ability to learn new products, services, procedures and support systems
- Ability to effectively prioritize and multi-task in high volume workload situations
- Flexible / adaptable with scheduling and commitments
Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.
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.
Keywords: Billing, Collections, Representative, Irving, TX