Senior Medical Billing Specialist

UnitedHealth Group•Tampa, FL

10h•$18 - $32•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Explore opportunities with American Health Network (AHN), part of the Optum family of businesses. Here, you'll be part of a team that offers quality, affordable care that's backed by a global organization, committed to improving the lives of those we serve. We operate in over 70 medical offices in Indiana and Ohio with 1,200 employees. Our markets are continuing to grow and we're looking for talented individuals who share our passion for quality care to join our team in provider or office positions. As a health-focused organization, we will empower you with resources that support your work-life flexibility as well as your physical, emotional and financial well-being. This is an opportunity to join a team that helps people feel their best and a chance to discover the meaning behind Caring. Connecting. Growing together.

Requirements

High School Diploma / GED OR equivalent work experience
Must be 18 years of age OR older
3+ years of current experience in a health care billing and collections environment OR a relevant health care setting using an accounting OR health care computer system
3+ years of experience utilizing ICD-10-CM, CPT, and HCPCS codes
3+ years of experience researching and resolving complex insurance receivables, denials, underpayments, appeals, and aging accounts
3+ years of experience working with major third-party payers, insurance plans, payer websites, billing requirements, and timely filing rules
3+ years of experience demonstrating the ability to interpret EOBs, remittance information, physician billing statements, payer correspondence, and patient account activity
Proficiency with basic PC applications, internet research, and health care billing systems
Ability to work full time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime.
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
Strong analytical, mathematical, auditing, reconciliation, problem-solving, and organizational skills
Excellent verbal and written communication skills, with the ability to communicate effectively with patients, physicians, management, third-party representatives, and internal partners
Ability to manage multiple priorities with speed, accuracy, attention to detail, and appropriate follow-through
Ability to work independently, retain composure, meet deadlines, and adapt to frequent interruptions in a fast-paced work environment
Demonstrated professionalism, dependability, sound judgment, and customer service skills
Ability to sit for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to receive and comprehend instructions verbally and/or in writing
Ability to communicate effectively verbally and in writing
Ability to use logical reasoning for simple and complex problem solving
Ability to maintain attention to detail and accuracy while managing multiple priorities and frequent interruptions
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nice To Haves

5+ years of current experience in a health care billing and collections environment OR a relevant health care setting using an accounting OR health care computer system
Successful completion of a coding and billing certificate program
Experience with Epic Professional Billing OR another Epic billing environment
Experience with accessing and retrieving information from an EHR
Advanced understanding of a variety of commercial, Medicare, Medicaid, managed care, workers compensation, OR other insurance plans, as applicable to the assigned inventory
Experience serving as a resource, trainer, mentor, OR peer coach in a billing OR collections environment

Responsibilities

Manage a significant inventory of insurance receivables, including complex, high-dollar, aging, denied, and underpaid physician billing accounts
Research account history, eligibility, benefits, coding, authorization, medical necessity, claim status, payment activity, contractual adjustments, and payer requirements to determine the appropriate resolution
Refile corrected claims, prepare and submit appeals, provide additional medical documentation, and complete timely follow-up through final account resolution
Analyze and reconcile Explanation of Benefits (EOB) information, remittance activity, payer correspondence, physician billing statements, and patient account balances
Initiate contact with payers, patients, internal partners, and other third parties; negotiate or coordinate appropriate resolution within established authority and guidelines
Respond to inquiries and correspondence from payers and patients with professionalism, accuracy, and courtesy
Explain patient financial liability, non-coverage determinations, EOB information, and physician service statements; process payments and payment plans in accordance with established procedures
Review account activity for accuracy and completeness, identify discrepancies or root causes, and take appropriate corrective action
Work escalated or technically complex accounts and provide subject-matter guidance to billing team members as needed
Support onboarding, peer coaching, and knowledge sharing related to payer websites, system workflows, account documentation, billing practices, and follow-up techniques
Identify recurring denial, reimbursement, documentation, or workflow trends and communicate findings to the Business Office Supervisor for review and process improvement
Maintain complete, accurate, and timely account notes and documentation in the applicable billing system and EHR
Prioritize assigned work, meet productivity and quality expectations, and manage deadlines in a fast-paced environment with frequent work-related interruptions
Perform duties in accordance with federal and state billing guidelines, payer contracts, industry requirements, and department policies and procedures
Maintain confidentiality and protect patient and business information in accordance with applicable privacy and security requirements
Demonstrate dependability, sound judgment, composure, attention to detail, and the ability to work independently
Provide a positive service experience through effective communication and exceptional customer service
Other duties as assigned