Senior Billing Representative - Remote Within Marlborough, MA

Healthcare isn’t just changing. It’s growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that’s what fueled these exciting new opportunities.

Who are we? Optum360 . We’re a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we’ll leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.

If you’re looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It’s an opportunity to do your life's best work.SM

All of us have a short list of the things that make a job great. If your list includes being able to make a difference, count us in as your next place to work. UnitedHealth Group is a Fortune 10 company leader in health care at a time when health care is evolving for everyone. Our billing teams are part of an important chain of events that impact the lives of our members in positive ways. Join this group and we’ll have an impact on you. Apply now and discover the exceptional training, support and opportunities to grow that you’d expect from a Fortune 10 company.

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 (8:30am - 5:00pm). It may be necessary, given the business need, to work occasional overtime. Our office is located at 200 Forest Street although due to COVID, this position will start out as Telecommute.

If you are located in the Marlborough, MA area, you will have the flexibility to telecommute* as you take on some tough challenges.

Training will be conducted virtually from your home.

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

What we do defines who we are. Take a deeper look at how we're providing support during this global health crisis and search for a way you can get involved. View our Covid-19 Resources Page at: https://info.uhg.com/

What makes this a special challenge? For one, we want to create a quality experience for every person we serve. So the bar is high for accuracy, communications style and effectiveness. Also, you’ll need to be researching and resolving problems before, during and after calls within a high volume, demanding environment.

Primary Responsibilities:

• Manage and track all stages of the claims process for non-contracted and contracted payors
• Generate accurate insurance claims in a timely manner
• Proactively follow up on claim status
• Review Explanation of Benefits statements and take appropriate action via verbal or written appeal to challenge low payments and various denials
• Ensures claims are paid according to contractual agreements
• Serve as a reimbursement resource for internal (client services, sales) and external customers (customers, payors, physicians)
• Answer incoming calls and electronic mail regarding patient billing and insurance inquiries
• Verifies eligibility, benefit information and prior authorization requirements or other pre-service review options
• Follow - up on outstanding AR balances by utilizing system queues and reports
• Identify payment trends that negatively impact accounts receivable by utilizing excel and other system generated reports
• Resolve claim issues with third party payors and patients
• Processing of incoming mail and correspondence
• Prepare and review bad debt and revenue adjustments (credits, refunds, transfers, etc.) in accordance with established guidelines
• Remains current on third-party coverage, reimbursement information and trends
• Monitors payer policy activities on technology coverage and payment
• Provide monthly AR report on assigned payors
• Maintain high level of integrity and confidentiality / patient privacy (HIPAA)

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)
• Understanding of Reimbursement, Health Care Plans, Claim Processing, Medical Terminology
• 2+ years of billing experience with medical billing and insurance collections
• Proven knowledge of and experience with ICD-10, HCPCS, and modifier coding
• Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications
• Proficient in Microsoft Excel with the ability to complete basic formulas, manipulate spreadsheets, sort / filter functions, etc.
• Must be located within Marlborough, MA
• 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
• Able to work a 40 hour schedule within the operating hours of the site
• You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
• Employees are 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 prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

• Associate's Degree (or higher)
• XIFIN experience

Soft Skills:

• Ability to multi - task and to understand multiple products and multiple levels of benefits within each product
• Must be flexible, able to effectively multi-task, and work effectively in a fast-paced, high volume work environment, dependable and possess the ability to work well independently as well as part of a team
• Analytical skills, prioritization skills, and time management skills
• Outstanding interpersonal, verbal, and written communications skills

UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography - specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

Some of the steps we’ve taken to ensure employee well - being include:

• Transitioned our new hire training classes to be conducted virtually
• Launched our ProtectWell app and UnitedCARES program to help ease the burden and stress for our UnitedHealth Group team members and their immediate family affected by COVID - 19
• Daily updates from our CEO Dave Wichmann to support and inspire team members during this challenging time
• Onsite social distancing and increased sanitization measures for employees who have been welcomed back to our offices
• Fully cover the COVID - 19 healthcare costs for our employees
• Employees who self - identify as high risk or who live with someone who is high risk have been asked to remain working from home

You can learn more about all we are doing to fight COVID - 19 and support impacted communities at: https://www.unitedhealthgroup.com/newsroom/addressing-covid.html

Taking care of business at UnitedHealth Group translates to more meaning and impact as you help improve the lives of millions. Join us. Learn more about how you can start doing y our life’s best work.SM

Careers with Optum360. At Optum360, we're on the forefront of health care innovation. With health care costs and compliance pressures increasing every day, our employees are committed to making the financial side more efficient, transferable and sustainable for everyone. We're part of the Optum and UnitedHealth Group family of companies, making us part of a global effort to improve lives through better health care. In other words, it's a great time to be part of the Optum360 team. Take a closer look now and discover why a career here could be the start to doing your life's best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Keywords: billing, healthcare, medical, insurance, claim development, remote, medical coding, medical billing, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately