Senior Insurance Representative

1 month ago

Brockton, Massachusetts, United States Optum Full time

Opportunities at Optum, in strategic partnership with Allina Health. As an Optum employee, you will provide support to the Allina Health account. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Revenue Cycle Insurance Specialist Senior assignments include the "RCM Insurance Specialist Associate and Intermediate" duties. The Insurance Specialist Senior may be called upon to provide assistance for projects and escalated issues within the department, assist in the development of the department's policy and procedures, and help provide training/ job shadowing to new employees.

If you are located in MN or WI, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

Understand edits and appropriate department procedures to effectively submit and/or correct errors on claims to the production standards of the departmentUtilize various resources such as third-party publications, procedure manuals and participating contractual agreements, etc. to reconcile accountsAdvanced knowledge and understanding to process third party rejections using the Payor system and the billing system. Follow-up on open accounts receivable, re-filing and department status proceduresUtilize Excellian and various systems and demonstrate understanding of procedures for registration/verification modules, Claims Processing system, Web based provider systems, etc, if applicable to positionTrend analysis, Appeals and Resolves of low payment or underpaid accounts Reports to lead and or supervisor observations of WQ's and workflow processes that may need further review and or developmentProcess and resolve complex denials related to coding and site operations (i.e.: CPT related, medical necessity, RAC technical denials etc)Ability to deal with difficult revenue cycle situations and resolve issues delaying/preventing payments from 3rd party payersMay be asked to provide job shadowing/basic training to other team members on the specific nuances of various job functionsMay assist in the design and development of department policies, procedures and tip sheets

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

3+ years of experience in revenue cycle operations2+ years of experience working with Epic1+ years of experience in billing follow up and resolving denials

Preferred Qualifications:

1+ years of experience in medical coding

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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.

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.

#RPO

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