Position Description: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.As a Business Office Specialist with Optum360, you will work with your team members to help identify and resolve issues and serve as a resource for day - to - day operations. Your primary role will be to contact and consult with patients and / or their families who have outstanding medical bills. While ensuring that payment is received for these bills is important, you will also need to provide assistance and support to these individuals as they may be dealing with a medical or financial crisis.Primary Responsibilities:Serve as a resource or Subject Matter Expert (SME) for other team members or internal customers to help identify and resolve issuesHandle escalated and complex customer issues, helping to provide resolution and settlement of accountContacts customers through a variety of methods (email, form letters and phone calls) to discuss, negotiate payment and resolve outstanding medical bill accounts and balancesObtains agreement, after discussion with customer, on potential balance payoff and / or payment terms within stated level of authority and guideline limitsPerforms research and documents on various computer systems customer information regarding current status, payment expectations, notes of conversations and other relevant informationPrepares and submits reports to internal management on status of outstanding medical bills and proposed / planned payment settlement detailsMay in some instances transfer settlement of account and related information to external collection agencies and remains in contact with them regarding further payment activity Reviews, documents, and analyzes all findings for payments, recoupments, and denialsUnderstands and articulates the client appeal rights with both government auditing programs Maintains strict adherence to appeal requirements and associated timeframesAdherence to timely completion of all assigned tasks within appeal softwareMaintain communication with payers, both government and non - government, and provide follow - up activity as necessitated to secure information regarding payment, re - coupments, denials, and clarification of correspondenceProvide reconciliation findings and escalate any trends or items of concernMaintains database information relative to financial activityOther duties as assigned by the Recovery Audit Supervisor, or designated Audit andDenials leadershipWorks independently in a team environmentMay act as a resource for othersMay coordinate other's activities
Required Qualifications:High School Diploma / GED1+ years of working knowledge of Medicare gained in a position primarily focused on Medicare1+ years of experience working with Medical Terminology, Procedure, and Diagnosis Coding sufficient to access accuracy of patient accountsProficiency with Windows PC applications (this includes the ability to learn new and complex computer system applications)Available to work 40 hours per week within the operating hours of the site (Monday through Friday 6:00 AM to 5:00 PM) and an occasional Saturday as needed for overtimePreferred Qualifications:2+ years of experience with data elements of UB04 and / or Electronic Claim Edit Suite experienceKnowledge of audits on government claimsCareers 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: Medical collections representative, customer service, collections representative, customer service representative, optum360
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.