| Position Description:|
Healthcare isnt just changing. Its 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 thats what fueled these exciting new opportunities.
Who are we? Optum360. Were a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, well 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 youre looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. Its an opportunity to do your lifes best work.
This function is responsible for medical and ancillary product premium billing. Positions in this function interact with customers gathering support data to ensure invoice accuracy and also work through specific billing discrepancies. Provide input to policies, systems, methods, and procedures for the effective management and control of the premium billing function. Educate customers regarding the availability of receiving invoices and remitting payments through online applications. Monitor outstanding balances and take appropriate actions to ensure clients pay as billed. Manage the preparation of invoices and complete reconciliation of billing with accounts receivables. May also include quality assurance and audit of billing activities. Note: Positions mainly responsible for more general A/R activities which do not include medical and ancillary premium billing activities can be found in the Accounts Receivable function in the Finance job family. Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.
- Interact with customers gathering support data to ensure invoice accuracy and also work through specific billing discrepancies
- Provide input to policies, systems, methods, and procedures for the effective management and control of the premium billing function
- Educate customers regarding the availability of receiving invoices and remitting payments through online applications
- Monitor outstanding balances and take appropriate actions to ensure clients pay as billed
- Manage the preparation of invoices and complete reconciliation of billing with accounts receivables
- May also include quality assurance and audit of billing activities
- Responsible for daily management of third party accounts receivable process and follow-up
- Will maintain department standards on quantity and quality of accounts worked daily, accuracy of detail, documentation of work done, this includes daily screening and correcting of claims for accuracy as determined by department policies and procedures
- Responsible for maintaining aged trial balance accounting of all accounts receivable status
- Review, correction and completion of edit lists, including tool kit edits, weekly as assigned (This requires the employee to be diligent and take the required initiative to ensure the entire account is corrected, not just the invoice (s) on the list to be corrected)
- Follow-up on original and pending claims
- The employee is expected to call the insurance company, document the findings and gather and send the necessary documentation to process the claims and document in PCS the standing of the claim
- Resolve claims appeals
- Once a claim is denied and an appeal is appropriate, appeals are to be done on timely basis in order to avoid the filing limit
- The employee must be knowledgeable regarding what can be appealed and what is not
- This includes gathering the information necessary to process the appeal accurately, including but not limited to, the review of payer guidelines, payer EOBs, physician documentation, authorization and eligibility verification, working with the coding representative for a prospective charge correction, as well as accessing all systems available to research information to appeal the denial
- The employee must have a clear understanding of the entire appeals process from start to finish and also be able to work effectively with the Billing Manager
- Effectively work PCS work files and compile ATBs for the monthly review.
- Respond to patient inquiries
- Each employee is responsible for handling customer service calls
- Employees must demonstrate excellent customer service skills, listening, problem solving, and respond to calls in a professional manner
- If unable to resolve, he/she must write up a complaint form when necessary and escalate it to the Billing Manager.
- Ad hoc projects
- When required, the employee must complete the project within the specified time frame
- The employee is responsible for gathering and compiling information relevant to the project, log the findings and complete a final documented report
- Each employee is expected to respect his or her co-workers and Management
- Each employee must possess good interpersonal skills and demonstrate team work
- Each employee must possess excellent organizational skills. When asked questions by Management, each employee is expected to have the knowledge and detail or know how to obtain it
- The work area is expected to be neat and clean at all times
- Each employee is expected to adhere to the rules and regulations of Optum
- Each employee must demonstrate initiative, independence, and a willingness to learn new tasks
- They must be able to work with minimal direction
- Each employee must be able to work as a team and collaborate and contribute to solving problems
- Moderate work experience within own function
- Some work is completed without established procedures
- Basic tasks are completed without review by others
- Supervision/guidance is required for higher level tasks