Billing and Prior Authorization Specialist

UnitedHealth Group•Lake Success, NY

18h•Onsite

About The Position

Optum NY/NJ is seeking a Biller/Prior Authorization Specialist to join their team in Lake Success, NY. Optum is a clinician-led care organization focused on improving healthcare. As a member of the Optum Care Delivery team, you will contribute to the vision of making healthcare better for everyone. Optum provides clinical resources, data, and support from a global organization to help patients live healthier lives. The Lake Success Rheumatology office has an opening for a Billing and Prior Authorization Specialist who is friendly, patient-focused, and detail-oriented. This role is responsible for completing set processes and protocols, working cooperatively with the care team to support the organization's vision and mission, deliver excellent customer service, and adhere to Lean processes. The specialist will support the team in meeting financial, clinical, and service goals.

Requirements

High School Diploma/GED
1+ years of computer proficiency experience in Microsoft Office
1+ years of experience working in medical office position performing duties such as insurance verification, obtaining pre-authorization, reviewing claims for errors before submission and maintaining appropriate medication schedules

Nice To Haves

Experience working with an electronic health record (EPIC)
Knowledge of medical terminology
Knowledge of CPT and diagnosis codes
Ability to work independently and maintain good judgment and accountability
Demonstrated ability to work well with health care providers
Strong organizational and time management skills
Ability to multi-task and prioritize tasks to meet all deadlines
Ability to be empathetic and kind towards patients
Ability to work well under pressure in a fast-paced environment
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

Responsibilities

Load or update insurance information as needed
Knowledge of Infusion scheduling by medication treatment plan based on standards of care
File and fax records
Answers incoming phone calls in a courteous and prompt manner; directs calls and takes messages
Ability to maintain a work queue list- complete any pending actions i.e. referrals, scheduling appointments
Confirms and schedule appointments
Verify eligibility and authorization and flag appointment accordingly
Verifies insurance coverage, benefits, and creates price estimates, reverifications as needed
Ability to discuss with patients balances and co-pays
Schedule appointments using approved scheduling guidelines
Use call processing and other applicable functionality in the EHR to take messages and communicate with clinicians
Monitor administrative tasks in the EHR and respond timely
Assist coworkers as needed to ensure smooth office operation and delivery of excellent service through teamwork
Demonstrate respect for patients and Optum staff by presenting a friendly, courteous manner always and maintaining patient confidentiality
Manage claims denial
Interact with customers to gather support data to ensure invoice accuracy and work through specific billing discrepancies
Provide input to policies, systems, methods and procedures for the effective management and control of the premium billing function
Educate customers regarding the availability of receiving invoices and remitting payments through online applications
Monitor outstanding balances and take appropriate actions to ensure clients pay as billed
Manage the preparation of invoices and complete reconciliation of billing with accounts receivable
Knowledge of diagnosis and CPT codes
Manage appeals and follow up with pharmacies and insurance companies
Perform other duties as assigned