Job Details
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Accounts Payable Provider - Reimbursement Specialist is responsible for investigating and processing appeals and grievances received by veterans or providers. This is a challenging role with serious impact, Specialist work collaboratively with other internal and external functional areas and stakeholders as necessary to resolve the case within the allocated timeframes.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Analyze/research/understand how a claim was processed and why it was denied
- Obtain relevant medical records to submit appeals or grievance for additional review, as needed
- Leverage appropriate resources to obtain all information relevant to the claim
- Identify and obtain additional information needed to make an appropriate determination
- Obtain/identify contract language and processes/procedures relevant to the appeal or grievance
- Work with applicable business partners to obtain additional information relevant to the claim (e.g., Network Management, Claim Operations, Enrollment, Subrogation)
- Determine whether additional appeal or grievance reviews are required (e.g., medical necessity), and whether additional appeal rights are applicable
- Determine where specific appeals or grievances should be reviewed/handled, and route to other departments as appropriate
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:
- High school education or equivalent experience
- 2+ years of experience processing medical and or dental claims
- 1+ years of experience with PCs and Microsoft office, including Outlook (calendar management, sending correspondence), Word (drafting, sending and saving documents), Excel (basic formulas, creating and sending spreadsheets) and Power Point (creating, sending and saving presentations)
- Ability to work independently
- Exceptional time management skills
- Ability to create professionally written emails to providers
- Exceptional phone etiquette skills
- Superior Customer Service
Preferred Qualifications:
- Applies knowledge/skills to a range of moderately complex activities
- Demonstrates great depth of knowledge/skills in own function
- Sometimes acts as a technical resource to others in own function
- Proactively identifies solutions to non-standard requests
- Solves moderately complex problems on own
- Works with team to solve complex problems
- Plans, prioritizes, organizes, and completes work to meet established objectives.
- May coordinate work of another team member
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for this role is $16.54 to $32.55 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
Optum, a part of the UnitedHealth Group family of businesses, continues to evolve and make a bigger impact through its extensive expertise in combining technology, data, and people to create novel health care solutions and services across the globe. OptumServe is following suit by creating and delivering care that meets the health needs of active-duty service members, veterans, and their families. We're partnering with federal and state government agencies to meet the readiness and health needs of active-duty military members and veterans by providing preventive health screenings and assessments to ensure that troops are ready to answer the call of duty. For those who want to intensify their impact in a career that brings together challenge, learning and growth, OptumServe is the right place to do your life's best work.SM
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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
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UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are... Read more