Help us maintain the quality of jobs posted on PowerToFly. Let us know if this job is closed.
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. Responsible for processing, auditing, and adjusting all facility medical claims, appeals and prepayment audits. Answers incoming telephone inquiries, and accurately and thoroughly documents problems and resolutions. Troubleshoots claims that have been identified as needing additional work in the areas of eligibility, referral authorization and contracting or provider set-up. Trains and assists other analysts with problem claims and escalated telephone calls. Primary Responsibilities:
- Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer
- Processes all types of medical claims and adjusts medical disputed claims (Professional and Facility) according to department, contract, and regulatory requirements
- Performs prepayment audit on all types of medical claims (Professional and Facility) according to department, contract, and regulatory requirements
- Answers telephone inquiries through the “Automated Call Distributor (ACD) Telephone System” as needed
- Identifies individual provider needs and takes appropriate steps to satisfy those needs
- Updates authorization information based on information obtained from provider
- Troubleshoots problem claims to resolve provider issues or systematic issues
- Verifies and interprets information in all vendor contracts to resolve issues
- Trains analysts and monitors general office support functions as needed
- Analyzes work processes, identifies areas needing improvements and initiates necessary steps to make changes
- Participates in the continuous quality improvement of IMCS core business system
- Follows unit procedures for performing call processing, claim adjustments and denials and references Policies and Procedures, job aides, provider contracts, and other reference materials to assure complete and accurate decisions
- Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Commercial and/or Medicare Facility claims processing experience and knowledge of AB1455 regulations
- 2+ plus years of healthcare claims processing experience in a managed care environment with at least 2+ years working with facility provider disputes
- Proven extensive knowledge of medical terminology, standard claims forms and facility billing coding, ability to read/interpret contracts, standard reference materials(PDR, CPT, Revenue, HIPPS, ICD-10, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge
- Proficiency with Microsoft Office to include Outlook, Excel, Word, etc.
- Ability to train onsite in our El Segundo, CA office for 4-6 weeks
- Experience in an indemnity and/or HMO setting processing, auditing, or adjusting facility claims
- Ability to process a variety of complex PDRs – Dialysis, Home Health, Skilled Nursing and Inpatient and Outpatient
About the Company
UnitedHealth Group
Minnetonka, MN, United States
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