Senior Billing Representative

National Remote Billing Specialist

Explore opportunities with Optum, in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together.

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 8:00 am - 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of the training will be during normal business hours.

Primary Responsibilities:

• Ensuring that coding and up front claim edits are resolved timely so claims can generate.
• Accurately billing all patient claims to their specific insurance companies.
• Conducting appropriate account a follow - up on unpaid, underpaid or overpaid balances.
• Working all associated correspondence received.
• Working collaboratively with patients and their insurance companies to secure payment due.
• Understanding place of service codes for professional billing.
• Understanding general medical terminology.
• Demonstrates understanding of various denials including but not limited to medical necessity, experimental, drugs, and laboratory.
• Demonstrates how to effectively appeal / overturn denials resulting in accurate reimbursement.
• Possesses knowledge of payer policies and guidelines to successfully overturn denials.
• Proactively contacts insurance companies on past due balances and utilizes critical thinking skills to determine the most expedient way to get claims paid; This could also include contacting provider representatives or contact specialists.
• Identifies and brings forth to management, any denial trends related to procedures, coding, and physicians.
• Obtains supporting documentation necessary to resolve insurance company denials and submits information to the insurance company using appropriate appeal forms.
• Monitor all assigned edit work lists, performing appropriate steps necessary to resolve all accounts in a timely manner; This includes timely responses for medical records requests, completion of additional information requests, etc., as requested by insurance companies.
• Demonstrates excellent communication skills either verbally or written, by promptly and professionally answering or responding to phone calls, voicemail, or email.
• Demonstrates effective personal time utilization, which includes appropriate levels of non - business - related talking, personal phone calls, breaks, lunch, tardiness and absenteeism.
• Other duties as assigned.

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age OR older
• 3+ years of physician billing experience
• Working knowledge of the claim denial process, including the Health Insurance Claim Form (HCFA)
• Ability to navigate multiple programs and learn new and complex computer system applications
• 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 8:00 am - 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Ability to understand adjudication process in determining how a claim has been paid
• Ability to work necessary claim edits prior to the claims going out to the payers, for accuracy, coding, registration, and / OR payer guidelines

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 and to understand multiple products and multiple levels of benefits within each product
• Ability to work autonomously

*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 hourly pay for this role will range from $20.38 - $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.

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.