Insurance Follow up Representative
About The Position
The Insurance Follow Up Representative works in Optum’s Business Services department to obtain timely payment on outstanding receivables for patients, clinicians, and staff. The role resolves payment delays by contacting payers, checking claim status through appropriate websites and payer portals, investigating denied claims, and identifying payer or clinic trends that may cause inaccurate or delayed reimbursement. It verifies that insurance liability has been met before patient liability is assigned and works to reduce avoidable write-offs and losses. The representative independently handles straightforward payer contracts and guidelines, resolves eligibility denials, and performs claim follow-up actions such as correcting rejections, updating registration information, writing and processing appeals, submitting corrected claims, and rebilling. Billing-related denials may require increased support, and issues are escalated to leadership as appropriate. The role manages an assigned worklist, follows standard procedures, and meets management’s production and quality standards, including measures for claims aged over 90 days. This is a full-time remote position for candidates residing in the Pacific or Mountain time zones. Employees must be flexible to work assigned shifts during normal business hours of 7:00 a.m. to 3:30 p.m. Pacific time, Monday through Friday, and may occasionally work overtime. On-the-job training is provided. Remote employees must maintain a private, dedicated work area, secure sensitive company documents, and have access to an approved high-speed internet connection.
Requirements
- High school diploma or GED, or equivalent work experience.
- Must be at least 18 years of age.
- At least 2 years of experience in insurance follow-up, including denial follow-up and appeals reconsiderations.
- Experience writing and processing appeals.
- At least 2 years of working knowledge of EOBs, COB, remits, and CMS 1500 forms.
- Working knowledge of CPT and diagnosis coding, medical terminology, and basic anatomy.
- Knowledge of medical insurance plans, processes, and requirements.
- Experience using computers and Windows PC applications, with the ability to learn new and complex computer system applications.
- Ability to work full-time Monday through Friday and flexibility to work assigned shifts during business hours of 7:00 a.m. to 3:30 p.m. PST; occasional overtime may be necessary.
- Reside within the Pacific or Mountain time zone.
- Ability to keep company-sensitive documents secure, if applicable.
- Maintain a dedicated work area separated from other living areas that provides information privacy.
- Live in a location able to receive a UnitedHealth Group-approved high-speed internet connection or use an existing high-speed internet service.
- Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.
Nice To Haves
- CPC certification.
- Multi-specialty clinic experience.
- Epic experience.
- Experience working with Medicare and Medicare Advantage.
Responsibilities
- Contact insurance carriers and patients about outstanding claims to obtain appropriate payment based on EOBs and/or Experian contract modeling expectations.
- Use knowledge of clinic operating policies to help identify root causes of denials.
- Prepare documentation for appeals to insurance carriers.
- Appeal claims that payers have reimbursed incorrectly.
- Ensure accounts are set up correctly in computer systems using knowledge of accounts receivable software, eligibility requirements, the internet, and payer portals.
- Apply knowledge of insurance carrier procedures, processes, and contract reimbursement rates for individual carriers and networks.
- Examine documents for accuracy and completeness and prepare records according to detailed instructions.
- Meet production and quality standards established by management.
- Manage an assigned worklist and follow standard work to resolve no-response claims, address denied claims, reduce claims aged over 90 days, and prevent avoidable adjustments.
- Maintain over-90-day aging quality measures according to payer baselines and expectations.
- Escalate issues to leadership as appropriate and perform other assigned tasks.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase program.
- 401(k) contribution, subject to eligibility requirements.
- On-the-job training.
- Career development opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
