You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.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 Insurance Follow Up Representative 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.This position is full-time (40 hours / week), Monday - Friday. Employees are required to work our normal business hours of 7:00 AM - 3:30 PM PST (Pacific Standard Time). It may be necessary, given the business need, to work occasional overtime and schedule may vary depending on team and training.We offer weeks of paid training. The hours of training will be based on your schedule (follows the same hours except 2 days when they will start at 8:00 AM) or will be discussed on your first day of employment.All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.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 experience in Insurance follow up
1+ years working knowledge of EOB, COB, Remits, and CMS 1500.
1+ years in appeal writing and processing
Working knowledge of CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy
Proven knowledge of insurance (plans, processes, requirements)
Computer aptitude - Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system application
Ability to work any full-time (40 hours / week) shift between the hours of 7:00 AM - 3:30 PM PST (Pacific Standard Time) from Monday - Friday including the flexibility to work occasional overtime based on business need
Must be 18 years of age OR older
Preferred Qualifications:
Multi - specialty clinic experience
CPC Certification
Customer service OR billing experience
Telecommuting Requirements:
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Soft Skills:
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
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $16.00 - $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.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.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