Financial Reviewer II - Kelsey-Seybold Clinic - Main Campus

UnitedHealth Group•Houston, TX

1d•$20 - $36•Onsite

About The Position

Under the supervision of the Administrative Supervisor/Clinic Administrator, the Guarantor Account Analyst researches assigned guarantor accounts and resolves billing issues by contacting patients/insurance carriers regarding outstanding balances (patient contact includes phone and face-to-face interaction). The ability to audit and reconcile an account is critical to this position, with aged guarantor balances representing over one million dollars in outstanding revenue annually. Interprets plan benefits in relationship to area of responsibility for Specialty Care Services (i.e. OBGYN, Orthopedics) and uses strong interpersonal/persuasive abilities in order to secure accurate and timely account resolution. Maintains effective communication and professional interaction with patients, physicians and fellow co-workers. Conducts duties in accordance with industry standards and in compliance with department policy & procedure. Must be able to meet Operations standards for established production and quality standards. Must also demonstrate understanding of correct adjudication relative to assigned Specialty Care services (i.e. OBGYN, Orthopedics) and have a proven track record of additional reimbursement from insurance carrier as well as from guarantor.

Requirements

High school diploma
5+ years medical office collections (both self-pay and insurance) with guarantor account follow-up, successful appeals outcomes and the ability to interpret plan benefits/payment methodology by primary and secondary health plans OR 2 years similar experience with an Associate or higher degree
Basic PC Literacy, Alpha/Num Forms Entry, Medical Terminology, CPT & ICD coding experience and Use of physician billing systems and interpretation of Explanation of Benefits (EOB’s)
Detailed knowledge of healthcare insurance to include diversified understanding of rules and regulations of Commercial Insurance with appeals experience (claims denials)
Able to utilize Microsoft products (Excel and Word)
Proven analytical skills to include interpretation of guarantor account balances with problem resolution
Proven ability to work independently and display teamwork qualities among peers and other department personnel
Proven ability to work independently and be self directed/able to absorb new material quickly
Proven excellent telephone etiquette with demonstrated capability to meet with patients one-on-one and explain payment methodology by the insurance carrier
Proven excellent interpersonal communications skills and strong written and verbal communication skills for staff and patient interaction

Nice To Haves

Certified/Licensed Medical Billing
1+ years of college, successful completion of Medical Billing & Coding class
1+ years of KSC Epic practice management system experience
Proficiency in Microsoft Word and Excel
Proven ability to handle a variety of tasks with speed and attention to detail

Responsibilities

Researches assigned guarantor accounts and resolves billing issues by contacting patients/insurance carriers regarding outstanding balances.
Audits and reconciles accounts.
Interprets plan benefits in relationship to area of responsibility for Specialty Care Services (i.e. OBGYN, Orthopedics).
Uses strong interpersonal/persuasive abilities in order to secure accurate and timely account resolution.
Maintains effective communication and professional interaction with patients, physicians and fellow co-workers.
Conducts duties in accordance with industry standards and in compliance with department policy & procedure.
Meets Operations standards for established production and quality standards.
Demonstrates understanding of correct adjudication relative to assigned Specialty Care services (i.e. OBGYN, Orthopedics).
Achieves a proven track record of additional reimbursement from insurance carrier as well as from guarantor.
Trains front desk staff on interpreting guarantor account activity.