Senior Insurance Specialist – Skilled Nursey Facility

UnitedHealth Group • Golden Valley, MN

8h • $20 - $36 • Hybrid

About The Position

This position follows a hybrid schedule with 1 days in-office days per week. Our office is located at 3915 Golden Valley Rd, Golden Valley, MN 55422.
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
This position will administer full cycle billing for the Skilled Nursing Facility (TRP) including Private Pay, Medicare, Managed Care and other third-party payer claims, authorizations, customer service and collections for the Courage Kenny Rehabilitation Institute. This position is responsible for verifying insurance coverage and skilled nursing facility benefits, submission of concurrent prior authorization requests, the preparation and submission of complete and accurate claims, and for timely and effective resolution and follow up on collections as well as customer service for the TRP clients and their families. This position will interface with clients, family members, therapy team, social services and admissions staff, as well as health plan case managers and/or contacts and various other facility departments.
This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30 am – 4:00 pm. It may be necessary, given the business need, to work occasional overtime.
Must be fully available for onsite training Monday – Friday 7:30 am – 4:00 pm CST for onboarding

Requirements

• High School Diploma/GED
• Must be 18 years of age OR older
• 2+ years of experience in full cycle billing for Skilled Nursing Facilities to include experience with Medicare (Part A and B), Medicaid, and primary and secondary Managed Care payers
• Experience and understanding of state, federal, third party, and private pay billing and reimbursement procedures and collection practices
• Customer Service skills with an exceptional ability to listen and communicate to others
• Proficient with computers and Microsoft programs including Adobe PDF, Word, Excel, and Outlook
• Located within a commutable distance of Golden Valley, MN
• Flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30 am – 4:00 pm.
• Reside within commutable distance to the office at Our office is located at 3915 Golden Valley Rd, Golden Valley, MN 55422.
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nice To Haves

• Accurately interpret billing information to identify problems and collect appropriate data to provide resolution
• Manage a variety of tasks, often with frequent interruption, switching from task-to-task
• Collaborate in a team environment and be willing to assist other departments as needed
• Organize and prioritize the work effectively with minimal supervision
• Handle and manage financial payments. Comfortable discussing financial matters with patients and/or other financially responsible parties, including requesting payments as due
• Develop rapport with a wide variety of customers in a short timeframe
• Experience with Point-Click-Care
• Work in multiple programs and systems

Responsibilities

• Verify eligibility and benefits of patient accounts
• Complete eligibility query and SNF benefit verification using electronic resources or phone at notice to admit, monthly (Medicare/Medicaid), and/or anytime benefit status changes.
• Identify benefits via electronic resources/phone; interpret results and enter into Point Click Care.
• Complete extended benefit check when requested by Social Workers or Case Managers.
• Obtain and track Prior Authorizations
• Submit Prior Authorization requests for continued inpatient stay and/or ancillary therapy required based on payer, completing payer specific forms, gathering documentation as necessary.
• Monitor and track PA renewals due and responses.
• Notify team of PA denials and communicate financial impact to clients/family, providing cost estimates as applicable.
• Funding/Coverage set-up, Point Click Care & Net Health
• Maintain accurate client information and client funding information in Point Click Care and Net Health Ensure systems have compatible information so they can communicate with one another.
• Ensure compliance on insurance claims through editing, review, filing, status, and follow-up
• Review, correct and update claims based on edits to support accurate and compliant claims submission
• Perform follow up on claims such as status checks, denials, appeals, corrections and records requests Pursue underpaid claims. Review and appeal denied claims to resolution
• Administer self-pay accounts
• Review and pursue collection of unpaid self-pay/ private pay balances.
• Review monthly statements, perform outbound collection calls, send letters on past due accounts.
• Assist clients via phone and in-person with financial assistance information and payment options.
• Provide customer service support
• Perform Financial overview meeting with new admits as assigned, providing outline of payer benefits, out of pocket estimated costs.
• Greet patient in a respectful, warm, and professional manner by phone and in-person.
• Follow appropriate processes to provide accounts receivable support on patient’s financial account.
• Partner with external departments and provide necessary support on SNF case work
• Field questions, provide direction and assistance as needed to non-TRP departments located on the Golden Valley Campus who are providing services to the TRP client/patients.
• Partner with MES worker on patient status and updates for TRP Medicaid applications.
• Research and resolve credit balances
• Research credit balances to issue refund and/or process replacement claims for recoupment of overpayments as necessary.
• Perform other duties as assigned
• Provide support to Admissions Teams regarding Payer Prior Authorization tools and resources, assisting with problem solving as needed.
• Analyze and review accounts to identify procedural inefficiencies and make recommendations to improvements to supervisor or manager.
• Train new employees on department specific processes.
• Develop and maintain procedures related to department processes.

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED