Reimbursement Specialist - Hybrid -Worcester, MA (99077614)
Opportunities with Reliant Medical Group. When you join Reliant, you’ll be part of a community-based, multi-specialty, physician-led medical group. Everyone works collaboratively on a common purpose: improving the quality, cost and experience of health care. With the resources of a global health organization - Optum - behind us, we’re at the forefront of value-based care. Supported by a patient-centric business model - integrated care teams focus on the best patient care, rather than volume. Here, you’ll contribute to an exceptional patient experience. Discover a place where you can help shape the future of health care and do your life’s best work.(sm)
This position is responsible for maximizing reimbursement on all outstanding third party accounts receivable.
- Follows up on outstanding receivables following standard procedures to ensure timely completion of assigned work. Resolves discrepancies within position responsibilities, refers exception items to manager or others
- Contacts insurance carriers utilizing phone, web sites, etc. to reduce accounts receivable (A/R) dollars and days
- Utilizes the current billing software to follow up on all outstanding third party receivables
- Ensures that claims meet all governmental and third party payer regulatory guidelines
- Initiates refunds when appropriate for all third party insurance receipts in accordance with governmental and insurance contracts and agreements
- Ensures appropriateness of payer rejections and denials, ensuring that appeals are processed timely in accordance with Revenue Operations Metrics
- Communicates both by phone and written communication with the organization’s providers, staff and payer representative to facilitate the reimbursement process
- Reports productivity and other data as requested by manager or others
- Cooperates fully with all governmental and third party insurer audits
- Complies with health and safety requirements and with regulatory agencies such as DPH, etc.
- Complies with established departmental policies, procedures, and objectives
- Enhances professional growth and development through educational programs, seminars, etc.
- Attends a variety of meetings, conferences, and seminars as required or directed
- Performs other similar and related duties as required or directed
- Regular, reliable and predicable attendance is required
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.
- High School diploma with additional specialized courses and 1+ years of reimbursement experience
- Demonstrated knowledge of third party billing
- Demonstrated knowledge and understanding of the details of payer and patient remits
- Knowledge of a variety of software applications such as Microsoft Word, Excel, Outlook, etc. as well as the internet
- Show proficiency in current billing system within 6 months
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
- Excellent interpersonal, communication and organizational skills
Unless certification, licensure or registration is required, an equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed in this description, may be substituted for the above requirements.
- Physical health sufficient to meet the ergonomic standards and demands of the position
The Organization reserves the right to modify position responsibilities at any time, due to business necessity.
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Reimbursement Specialist, Reimbursement, 3rd Party Billing, Payments, Worcester, MA, Massachusetts