Collections Representative - Phoenix, AZ

Unitedhealth Group Inc. Phoenix , AZ 85002

Posted 2 months ago

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.

Primary Responsibilities:

  • Ensure all claims are billed and received by the payers for proper adjudication. This includes timely processing of allocated volume of accounts, based on established production guidelines and time parameters provided for workflow

  • Responsible for outbound calls and / or status inquiries via payers website validating receipt of medical claims and adjudication status within established timeframes

  • Display competent ability to access, navigate, and manage account information through phone calls and payer websites

  • Work any edits and denials in allocated workflow to achieve proper adjudication to payment. This includes, but is not limited to: verify insurance is correct, update insurance demographics, rebill claims not received, document the status of work performed, follow - up on outstanding adjudication items according to departmental guidelines, and is also responsible for billing secondary / tertiary claims along with providing supporting documentation to payers for additional payment

  • Perform scheduled follow up on accounts to include calls to payers and / or patients, as well as accessing payer websites, and resolving complex accounts with minimal or no assistance necessary

  • Effectively resolve complex or aged inventory, including payment research and payment recoups with minimal or no assistance necessary

  • Document all work and calls performed, in accordance to policy. This includes complete contact information, good grammar, and expected outcomes

  • Obtain primary and / or secondary EOB and claims to bill next responsible payer, along with utilizing various internal resources to obtain medical records to respond to requests from payers upon request

  • Accurately and thoroughly documents the pertinent collection activity performed

  • Maintain assigned worklists and resolve high priority and aged inventory

  • Identify and communicate issues to leadership, including payer, system or escalated account issues for timely resolution

Required Qualifications:

  • High School Diploma / GED (or higher)

  • 2 years of experience in Medical Collections

  • Ability to create, copy, edit, send, and save within Microsoft Word (creating and editing documents), and Microsoft Outlook (open and send emails and meeting requests)

  • Experience and working knowledge of Microsoft Excel (create spreadsheets, pivot tables and formulas, data entry, reviewing reports, sort / filter and open / edit / saving documents)

  • Understanding of medical terminology, diagnosis codes, denial codes, ICD10 Codes and calculating fee schedules

  • Understanding of UB's and Remittance Advise (RA's)

  • Ability to read and understand EOB's (Explanation of Benefits)

Preferred Qualifications:

  • 1 years experience Hospital Billing or Hospital Collections

  • Experience in interpreting Payer Contracts and determining accurate payments on patient accounts

Soft Skills:

  • Experience to know the appropriate questions to ask when calling Medicare to get the necessary information to move forward in resolving the claim

  • Ability to have a solid understanding of hospital claims and processes in order to review and analyze claims and account receivable functions

  • Able to identify trends when working claims and communicate this to their Supervisor timely for quick resolution

  • Ability to "think outside the box" to recommend innovative solutions

  • Highly motivated and able to work independently, comfortable with ambiguity

  • Ability to remain focused and productive each day though tasks may be repetitive

  • Ability to learn new products, services, procedures and support systems

  • Ability to effectively prioritize and multi - task in high volume workload situations

  • Flexible / adaptable with scheduling and commitments

Careers with Optum360. At Optum360, we're onthe forefront of health care innovation. With health care costs and compliancepressures increasing every day, our employees are committed to making thefinancial side more efficient, transferable and sustainable for everyone. We'repart of the Optum and UnitedHealth Group family of companies, making us part ofa 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 anddiscover 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: Hospital Billing, Collections, Representative, Phoenix, AZ, UHG, United Health Group


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