Primary Responsibilities:
Accurate processing and completion of Physician/Pharmacy Claims
Process claims that route out of automatic adjudication, within current turnaround standards
Be able to analyze EOBs and denials at a claim level in addition they should find trends impacting dollar and #’s, leading to process improvements
Analyze and trend data, recommending solutions to improve first pass denial rates and reduce age of overall AR
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
Graduation from a recognized university OR Equivalent degree
Minimum 12 months of experience in US healthcare accounts receivable (Denial Management)
Good knowledge of medical insurance (HMO, PPO, Medicare, Medicaid, Commercial Payers)
Comfortable working in night shift
Good typing speed (English) and accuracy
Proven excellent written and verbal communication skills
Ability to understand and apply US healthcare plan concepts including Deductible, Coinsurance, Copay, Out of Pocket, etc.
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.
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