Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.
The Manual Pricing / Balance Billing Representative is responsible for reviewing and analyzing claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced accurately; review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors; recommend system changes, training and process improvements to prevent future errors; work with both internal and external customers to identify and resolve complex problems. Position will involve manual pricing of claims that are not eligible for EDI routing or have been pulled from EDI in error. Requests for manual pricing are received and reviewed via Host ORS. Position will also involve review and analysis of balance billing inquiries regarding Out Of Network programs and working with outside vendors to resolve. Required to meet a production goals and quality standards.
Apply knowledge / skills to a range of moderately complex activities
Demonstrate great depth of knowledge / skills in own function
Sometimes act as a technical resource to others in own function
Proactively identify solutions to non-standard requests
Solve moderately complex problems on own
Work with team to solve complex problems
Plan, prioritize, organize and complete work to meet established objectives
Analyzes and investigates
Provides explanations and interpretations within area of expertise
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.