Collections Representative - Atlanta, GA

Unitedhealth Group Inc. Atlanta , GA 30301

Posted 5 months ago

Combinetwo of the fastest - growing fields on the planet with a culture ofperformance, collaboration and opportunity and this is what you get. Leadingedge technology in an industry that's improving the lives of millions. Here,innovation isn't about another gadget, it's about making Healthcare dataavailable wherever and whenever people need it, safely and reliably. There's noroom for error. Join us and start doing yourlife's best work.SM

The Collections Representative position is an Accounts Receivable function. To perform this job successfully, an individual must be able to perform each assigned essential duty satisfactorily.

This position is expected to have excellent reasoning skills based on knowledge of clinic operations as it pertains to billing claims to Insurance Health Plans and coding for medical diagnosis and procedural coding. Individual should be familiar with the conventions and instructions provided within the ICD disease classifications and CPT coding guidelines. Should also be able to reason through insurance claims differences as defined by benefit and plan differences.

This position is responsible for resolution of A/R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including, local, state, and federal regulations, regarding billing and collection practices are followed; as well as with established internal policy and procedure.

Primary Responsibilities:

  • Reviews medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed

  • Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation

  • Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information

  • Responsible for working EDI claim rejections in a timely manner

  • Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Medicare, or patients. Able to apply correctly to claims/ fee billed

  • Processes incoming EOBs to ensure timely insurance filing or patient billing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance

  • Responsible for processing payments, adjustments and denials according to established guidelines

  • Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts

  • Responsible for reconciling transactions to ensure that payments are balanced

  • Responsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures

  • Responsible for keeping current with changes in their respective payer's policies and procedures

  • Communicates with the Clinics to provide or obtain corrected or additional data

  • Prepare documents for training or for establishing procedures for clinics

  • Answer patient and customer questions regarding billing and statements

  • Performs all other related duties as assigned

Required Qualifications:

  • High School Diploma / GED (or higher) or equivalent

  • 2 years of experience in Patient Financial Services or Patient Accounting

  • 1 year of professional customer service skills

  • 1 year of MS Excel experience (filtering, editing, sorting, saving data to spreadsheets)

  • 1 year of work experience using MS Outlook or similar email system (calendaring, folders, emails)

  • Experience working with a PC and multiple programs/systems and the ability to learn new and sometimes complex program

  • 2 years of work experience with the following payers: Medicare, Medicaid, Managed Care & Commercial Payers

  • 2 years of experience with submission and resubmission of medical claims

Preferred Qualifications:

  • Technical skills in the areas of EDI, systems analysis and process flows

  • Coding certification

  • 50wpm typing skill

  • Knowledge of ICD, CPT codes and HCPCS coding

  • Knowledge of HIPAA compliance rules and regulations

Soft Skills:

  • Attention to detail

Careers with OptumInsight. Information and technology have amazing power to transformthe Healthcare industry and improve people's lives. This is where it'shappening. This is where you'll help solve the problems that have never beensolved. We're freeing information so it can be used safely and securelywherever it's needed. We're creating the very best ideas that can most easilybe put into action to help our clients improve the quality of care and lowercosts for millions. This is where the best and the brightest work together tomake positive change a reality. This is the place to do yourlife'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: medicare, Medicaid, Tricare,managed care, commercial, collections, claims, processing, billing,hipaa, medical coding, coding, financial, accounting, patient


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Collections Representative - Atlanta, GA

Unitedhealth Group Inc.