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.
The Associate Collections Representative is responsible for all follow – up activities ensuring accurate reimbursement from third party, or resolution of all assigned accounts in a timely manner. In additional, this position assist and provides education to other staff when issues arise.
This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 3:30pm PST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime.
We offer 4 weeks of on-the-job training. The hours of the training will be aligned with your schedule.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Perform daily, systematic reviews of unpaid, underpaid and denied accounts from the appropriate third-party payer source ensuring that all assigned accounts are paid and / or resolved in a timely manner
- Address all inappropriate denials and underpayment by writing an effective and concise Provider Dispute Resolution
- Identifies and analyzes underpayments to determine the reasons for discrepancies and processes denials and appeals; examines claims to ensure payers are complying with contractual agreements
- Communicates directly with payers to follow up on outstanding claims and resolve payment variances, responds to payer inquires and concerns, and works to develop and maintain positive relationship with payers
- Focus attention on payers with complex follow – up requirements, accounts with high dollar balances, aged accounts, denial trends, and other advances follow – up scenarios
- Notes denial trends and informs supervisor / manager of findings to mitigate future claim rejections
- Maintains a thorough understanding of federal and state regulations as well as specific commercial payer requirements in order to promote compliant in billing and follow – up
- Keep current on all commercial payer updates including contract languages, rates, policies and payer updates / changes
- Keep Supervisor / Manager informed of any potential impact to current billing and reimbursement
- Identifies compliance risk and proactively recognize and rectify any issues to prevent commercial payer’s audit
- Utilize Government and Commercial regulatory guidelines for collection of outstanding accounts
- Follow appropriate appeal process on denials, ensuring resolution
- As appropriate, reviews, investigates and resolves missed payments or credit balances
- Initiate appropriate adjustments, ensuring all necessary actions have been performed with the correct adjustment and amount
- Responds to patient concerns and / or complaints on a routine basis and keeps departmental leaders apprised of recurring issues
- Provide individual contribution to the overall team effort of achieving the department AR goal
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
- Must be 18 years of age OR Older
- 2+ years of experience in Physician Billing and follow – up / collection
- Knowledge with managed care contracts and appeal process
- Experience with and knowledge of personal computer application, including Microsoft Office Suite (Microsoft Word, Microsoft Excel, Microsoft PowerPoint, and Microsoft Outlook)
- EPIC experience
- Basic knowledge of medical terminology
- Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 3:30pm PST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime
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
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group – approved symptom screener. When in a UnitedHealth Group building
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy