Collections Representative - Medical Records or Audit

Medical Records Specialist

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing Together.

This position is full time (40hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer 4 - 8 weeks of on-the-job training. The hours during training will be 7:00am - 7:00pm CST, Monday - Friday. Training will be conducted virtually from your home.

Primary Responsibilities:

• Gather and Creating Medical Record Packets due to audits and payer requests.
• Log audit requests in Audit Tracking system.
• Mail, fax, or upload medical records accurately and efficiently within requested time frames.
• Review open AR and prioritize collection activities.
• Develop relationships with payers to obtain remits and resolve root causes.
• Assure that timely and accurate follow up activity is performed on all invoices.
• Responsible for review and documenting of key accounts.
• Identify issues / trends and escalate to Supervisor / Manager when assistance is needed.
• Identify and document bad debt write-offs and A/R adjustments.
• Identifies any overpayments and/or duplicate payments, with investigation and resolution.
• Create refund requests, in accordance with policies and procedures.
• Ensures secondary claims are accurately generated and submitted on a timely basis.
• Evaluates payments / denials received for correctness and ensures they are applied appropriately.
• Provide exceptional Customer service to internal and external customers.
• Work with offshore partners to ensure that exceptions are being resolved within the designated standard.
• Develop relationships with other departments to provide feedback about root cause issues.
• Adhere to Regulatory / Payer Guidelines and policies & procedures.
• Other duties as assigned.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age OR older
• 2+ years of Major Medical Insurance Collections OR Home infusion billing experience
• Medical record compilation experience
• Familiarity with payor audits
• Experience using Microsoft Word (edit, create & save documents)
• Experience using Microsoft Excel (editing spreadsheets)
• Experience using Microsoft Outlook (email)
• Experience using Microsoft Teams
• Ability to work 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 7:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Infusion Pharmacy experience
• Knowledge of NDC, ICD-10, and HIPAA

Telecommuting Requirements:

• 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.

Soft Skills:

• Reliable and consistent record of attendance
• Ability to follow complex processes and create solutions independently
• Strong problem-solving capabilities and time management within a fast-paced environment
• Ability to multi-task successfully and meet deadlines in fast-paced environment
• Demonstrate a willingness to listen, understand and acknowledge customers, co-workers, leadership and others in a collaborative, respectful and productive manner
• Demonstrate good judgement and professional initiative on all matters come across the desk, whether inside or outside the normal scope of the role

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $17.74 - $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.