Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.
The Biller/Collector position is an Accounts Receivable function. To perform this job successfully, an individual must be able to perform each assigned essential duty satisfactorily.
This position is expected to have excellent reasoning skills based on knowledge of clinic operations as it pertains to billing claims to Insurance Health Plans and coding for medical diagnosis and procedural coding. Individual should be familiar with the conventions and instructions provided within the ICD disease classifications and CPT coding guidelines. Should also be able to reason through insurance claims differences as defined by benefit and plan differences.
This position is responsible for resolution of A/R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including, local, state, and federal regulations, regarding billing and collection practices are followed; as well as with established internal policy and procedure.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Reviews medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed
- Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation
- Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information
- Working EDI claim rejections in a timely manner
- Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Medicare, or patients. Able to apply correctly to claims/ fee billed
- Processes incoming EOBs to ensure timely insurance filing or patient billing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance
- Processing payments, adjustments and denials according to established guidelines
- Reviewing insurance payer reimbursements for correct contractual allowable amounts
- Reconciling transactions to ensure that payments are balanced
- Reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures
- Keeping current with changes in their respective payer’s policies and procedures
- Communicates with the Clinics to provide or obtain corrected or additional data
- Able to prepare documents for training or for establishing procedures for clinics
- Answers patient and customer questions regarding billing and statements
- Performs all other related duties as assigned
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.
Years of post-high school education can be substituted/is equivalent to years of experience
Required Qualifications:
- High school diploma or GED equivalent
- 2+ years of relevant experience in the healthcare industry, with a focus on medical terminology and ICD/CPT coding
- Proficiency with Microsoft Office applications
- Proven solid attention to detail and professional customer service skills
Preferred Qualifications:
- Coding certification
- Proven ability to type 50 wpm typing skill
- Proven technical skills in the areas of EDI, systems analysis and process flows
California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $16.00 to $31.44 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.