A Healthcare Claims Denial Coordinator is responsible for monitoring his / her own work queue. On a regular day, the denial letter coordinator will run his / her queue report for compliance purposes. He / She will work on any claims close to compliance, including:Eligibility claims - DC will call the health plan or go on health plan website to verity eligibility. He / She will take the appropriate steps to get the claim finalized and/or issue denial letterOut of network claims - DC will contact referring physician or billing provider to verify if / how member was referred. With that information DC will finalize the claim accordingly and/or issue denial letterAll denial letters are reviewed by Supervisor for accuracy and appropriateness. Primary Responsibilities:Follows policy and procedures regarding Denial ProcessOrients internal staff to current changes in Denial ProcessWorks closely with Compliance Dept. to insure that denial letters have appropriate language as delineated by NAMM California, Health plans, CMS and DHMCProvide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claimsAnalyze and identify trends and provides reports as necessaryConsistently meet established productivity, quality, and compliance standardsProvide excellent customer serviceAbility to work as a team playerAbility to access health plan websites and verify eligibility information
Required Qualifications:2 years of HealthCare Claims processing experience3 years of experience analyzing and solving customer problems in an office setting environment using the telephone and computer as the primary instruments to perform job dutiesModerate Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications Preferred Qualifications:An education level of at least a high school diploma or GED or equivalent working experienceAbility to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each productKnowledge of CMS and DHMC compliance guidelines preferredExperience with ICD-10, HCPCS and CPT codes Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform. The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets. 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. Job Keywords: Claims processor, Medicare, denial process, compliance, health plans, CMS, DHMC, Ontario, CA, California
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.