Senior Audit Representative

Role Description

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 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.

Working under the general direction of the Executive Director Revenue Operations, Practice Management and Revenue Operations management, serves as the primary contact between designated practices and Revenue Operations for all aspects relating to the professional services Revenue Cycle. Responsible for the proactive management of the billing process for the client relationship and a full assessment and understanding of the practice’s revenue cycle. Partners with key Reliant Operational Practice Leadership, physician leadership and Revenue Operations Leadership to identify areas of opportunity to improve the revenue cycle.

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.

We offer weeks of on-the-job training. The hours of training will be aligned with your schedule.

Primary Responsibilities:

• Effectively manages group or practice’s expectations regarding financial performance. Develops expertise for assigned practice(s).
• Understands the implication of each element in the revenue cycle, communicates this to group/practice to engender an appropriate response. Provides interpretation to clients/Rev Ops Management.
• Develops interventions and initiates actions.
• Prioritizes initiatives with practice MDs or Directors on key performance issues. Provides practice(s) with updates on new initiatives within the Revenue Operations designed to improve billing performance.
• Develops and executes these initiatives and also provides the practices and Rev Ops Management with the status and analysis of standard operational, financial and billing statistics on a monthly basis.
• Proactively identifies opportunities for revenue cycle improvement initiatives. Assists in Experian technology, tools, contracts and workflows to EPIC underpayment tools. Assist in maintaining EPIC underpayment analysis and workflows as needed.
• Maintains ongoing issues and priority list for practice/Rev Ops. Focuses practice(s) on issues that will positively impact financial performance. Makes recommendations to address issues.
• Proactively identifies sources of issues and communicates to the appropriate parties.
• Consults with Management Team to identify issues and trends that contribute to variances in expected performance. Completes analysis of issues for action, presents this information and implements or supervises action plans.
• Performs ongoing claim analysis and quality audits of denial workflows and adjustments. Issues written quality audit reports to deliver ongoing feedback and training to staff.
• Provides updates on global issues regarding coding and reimbursement practice(s).
• Performs formal review of annual CPT/Diagnosis/HCPC changes.
• Creates and analyze monthly reports, prepare and present monthly analysis. Assists practice with statistical analysis.
• Develops expertise in querying system for data and reports. Works closely on interface and system issues as required to improve flow of data.
• Monitors practice activity utilizing the EPIC Dashboard and workbench reports.
• Provides practice(s)/Rev Ops Management Team with statistical reports using available and current reporting tools including but not limited to:
• Total encounters and charge reconciliations
• Monthly write-offs
• Payer rejections and claim denials
• Assesses impact of new regulations or codes from a coding, compliance and reimbursement perspective.
• Works collaboratively with clinical department physicians, mid-level providers and other staff to ensure appropriate coding and billing practices. Prepares and provides data and summary reports to clinical leaders on opportunities for front end provider and clinical coding and operational impacts to revenue improvements.
• Develops standardized approaches for operational issues, reporting, and analysis and quality management.
• Works collaboratively with Patient Financial Services, Registration, and Rev Ops, to ensure efficient processing and follow up on professional revenue.
• Handle master fee schedule adjustments and analysis as needed.
• Attends all department and Practice meetings as required.
• Participates in committees and task forces as assigned.
• Performs similar or related duties as required or directed.
• Regular, reliable and predictable attendance is required.

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.

Qualifications

• High school diploma / GED OR equivalent work experience
• 18 years of age OR older
• 3+ years of experience in medical claims
• 2+ years in medical billing
• Moderate proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Experience with EPIC
• Intermediate experience with Microsoft Excel
• Ability to work 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-5:00pm. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications

• Leadership 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

• Ability to multi-task
• Excellent communication, interpersonal, analytical and organizational skills
• Detail-oriented
• Self-starter

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

Company Description

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.

OptumCare 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.

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