Employer: UnitedHealth Group
job description:
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (8:00am – 5:00pm).
- It may be necessary, given the business need, to work occasional overtime.
- *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
- The Resolution Specialist is responsible for providing customer support functions for the Itemized Bill Review, Resolution Department.
- Analyze Resolutions of simple to complex nature and composing/drafting responses and related correspondence. Responsibilities for this role include, but are not limited to reviewing, analyzing, and responding to hospital inquiries, and complaints within established time frames; ensuring Resolution responses are complete, grammatically correct, and of a nature that appropriately represents the company’s position; maintain company’s Client Matrix and other reports or documentation as they relate to each client’s appeal standards and requirements.
- Manage incoming emails from providers, clients, and other departments and respond to turnaround time requirements.
- Manage follow-up phone calls and emails from providers, clients, and other departments and respond to turnaround time requirements.
- Provide customer service accurately and within established time frames
- Update internal records according to company protocol; examples include but are not limited to:
- Saving documents in client folders and in Clinical Point; and, updating internal records
- Provide general administrative support to the Resolution & Appeals Division; examples include but are not limited to:
- closing claims; emailing or faxing provider packets; setting up appeals; scanning, copying, saving, and faxing documentation; updating internal records; all according to company guidelines
- Acting as a departmental resource on Resolutions matters as required; performing research as warranted.
- Special projects as assigned
- Ensure that deliverable meets quality expectations.
- Contributing to the development of Resolution functions, including workflows, policies and procedures, staff training, and documentation
Primary Responsibilities:
- Provide quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to Resolution inquiries, and complaints within established time standards.
- Create, compose, and maintain Resolution response templates, and routinely review to update language, and apply and coordinate such updates and changes under the guidance of the Director of the Resolution & Appeals Division and other Management as appropriate.
- Communicate/interact with hospital providers (telephone, email, other written correspondence, participate in meetings) as required.
- Perform research and provide documentation for Resolution matters as requested within required time frames.
- Update claims (logs, dates, processes, documentation) in systems following company standards within established time standards.
- Update and maintain the accuracy of the Client Matrix for each client to ensure Resolution response requirements (such as timelines, policies, and procedures) are available for reference to set up claim Resolution / Appeals when received.
- Perform peer QA of Resolution responses as needed.
- Participate in department and company meetings as requested.
- Participate on committees and special projects (as assigned or required) to ensure consistency of the claim review from the initial report through the appeal process.
- Meet time, quality, and customer satisfaction standards.
- Complete special projects related to Resolutions as assigned, within required time standards
- 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 higher)
- 1+ years of relevant experience or equivalent combination of education & work within healthcare-related employment.
- 1+ years experience working in a production environment with production metrics and QA standards.
- 1+ years of working in a team atmosphere in a production driven environment, but additionally can work independently.
- Proficient in MS Office.
Preferred Qualifications:
- Bachelor’s degree (or higher)
- Coding Accreditations are desired
- An understanding of waste & error principles and health insurance experience desired
- 1+ years of Resolution / Appeal experience.
- Familiarity with Resolution / Appeal regulations, medical terminology, and coding.
- Familiarity with plan benefit, ERISA, Medicaid, and Medicare requirements.
- Knowledge of health insurance business, industry terminology, and regulatory guidelines.
Soft Skills:
- Candidate must be highly organized with effective and persuasive communication skills.
- Strong analytical, problem solving, and decision-making skills required; ability to interpret data and exercise good judgment.
- Strong analytical mindset
- Exceptional telephone and client service skills; ability to interact professionally in challenging situations
Telecommuting Requirements:
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Colorado, Connecticut or Nevada Residents Only:The salary range for Colorado residents is $15.00 – $22.02. The salary range for Connecticut / Nevada residents is $15.00 – $24.13. 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
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.