Credit Specialist

Credit Specialist

This position is remote in PST and CST. You will have the flexibility to work remotely 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Credit Specialist researches and resolves patient and insurance credit balances within the healthcare revenue cycle. This role reviews account activity, remittances, and supporting documentation to determine why a credit exists and how it should be resolved. The specialist initiates refunds, processes transfers and adjustments in the billing system, documents findings, and routes refund transactions for required review and approval. The role works with internal teams to resolve discrepancies and prevent incorrect refunds.

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 7:00 am - 5:00 pm PST. It may be necessary, given the business need, to work occasional overtime.

We provide up to 6 weeks of training aligned to your schedule. Training will be conducted virtually.

Primary Responsibilities:

• Research patient and insurance credit balances by reviewing payment history, adjustments, remittances, correspondence, and supporting documentation.
• Identify the cause of a credit, including duplicate or excess payments, payment posting errors, reversals, payer recoupments, or changes in patient or insurance responsibility.
• Determine the appropriate resolution of a credit, such as a patient refund, payer refund, transfer, or adjustment, in accordance with established policies and procedures.
• Initiate refund transactions in Epic, verifying the amount, recipient, and supporting documentation before submitting them for required review and approval.
• Research payer overpayments, including government payer overpayments, and follow applicable refund and documentation workflows.
• Review account information for discrepancies or conflicting payer information. Refer issues requiring correction or further validation to the appropriate team before proceeding with a refund.
• Process account transfers and adjustments, and document the research, actions taken, and resolution in the billing system.
• Respond to internal inquiries regarding credit balances, refunds, and account activity. Coordinate with billing, follow-up, payment posting, Finance, Treasury, and other partners as needed.
• Identify and route eligible unclaimed credits through the established escheatment process.
• Maintain accurate account notes and supporting records while meeting established productivity, quality, and turnaround expectations.
• Identify recurring causes of credit balances and communicate account findings or workflow issues to the supervisor

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 work experience
• Must be 18 years of age OR older
• 2+ years of experience in accounts receivable, billing, credit balance resolution, or a related financial transaction role in healthcare field
• Experience with Microsoft Office applications, including Microsoft Excel
• Ability to work 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 7:00 am - 5:00 pm PST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Experience in healthcare revenue cycle, medical billing, or credit balance resolution
• Experience with payment posting, including reviewing ERAs, EOBs, payments, and adjustments
• Experience researching patient and insurance overpayments and initiating refunds
• Epic experience

Telecommuting Requirements:

• Reside within Pacific Time Zone and Central Time Zone
• 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:

• Ability to research transaction history, identify discrepancies, and make sound decisions based on supporting documentation.
• Strong attention to detail, organizational skills, and written and verbal communication skills.
• Ability to manage a high-volume workload while meeting quality and turnaround expectations.

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $18 - $32 hourly based on full-time employment. We comply with all minimum wage laws as applicable.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.