Billing Quality Claims Analyst in Tampa FL
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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)
Positions in this function are responsible for all aspects of quality assurance within the Billing job family. Conducts audits and analysis and provides feedback to reduce errors and improve processes, design, and performance.
- Review insurance claims to identify billing issues/errors, and escalate as needed (e.g., overpayments, underpayments)
- Demonstrate knowledge of the autogenerated fulfillment process, as needed (e.g., how it is triggered, impact on premium billing)
- Review work samples from applicable reps/analysts to ensure quality/accuracy (e.g., billing processors, quality reps, collection reps)
- Ensure that patients'/members'/groups' chosen method of payment is set up correctly (e.g., monthly EFTs, SSA deductions, coupon books)
- Ensure proper resolution of billing payments/adjustments (e.g., refunds, cash application, revalidate underwriter's form, writeoffs)
- Ensure that bills properly reflect applicable insurance product rates, terms, and conditions (e.g., patients, customers, groups, membertomember)
- Ensure that all relevant information from insurance applications is accurately entered into applicable systems
- Demonstrate understanding of applicable quality review processes (e.g., corporate reviews, individual reviews, focus reviews, review to outcome analysis)
- Ensure that monthend sampling deadlines are met
- Provide support for external audit requests, as needed (e.g., SOX)
- Adhere to applicable billing and collection processes (e.g., account history letters, method of payment, credit on account, cash application, refunds, ODM correspondence, work queues, payment plans)
- Ensure timely invoicing of applicable customers/patients/groups Ensure timely completion of required billing documentation
- Identify and communicate solutions to gaps in billing processes/procedures
- Recommend/implement appropriate actions to remediate identified quality issues (e.g., training, process updates, policy changes)
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 education or equivalent experience
- CCA or CPC certification
- Billing/Collections and Cash Posting 1+ years of experience
- Athena or Allscripts system experience
- Knowledge of applicable billing system/platforms
- Knowledge of EOB’s Copays/coinsurance/deductibles/denial codes, and insurance allowable
- Knowledge CPT, ICD 10, and modifiers
- Solid knowledge of Medicare, Medicate and Manager Care
- Microsoft Word and Excel skills
- Good verbal and written communication skills
- Analytical and problemsolving skills
- Able to manage changing priorities and directives
- Ability to work under time constraints
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.