PB Billing and Follow Up Collections Representative - Concord, CA (106137753)
If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers, and our industry by shaping what health care looks like and doing your life's best work.SM
The PB Follow-Up Specialist I, is responsible for all follow-up activities ensuring accurate reimbursement from third party, or resolution of all assigned accounts in a timely manner.
This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business between 7:00AM - 4:00PM PST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 5003 Commercial Circle, Concord, CA 94520.
- Perform daily, systematic reviews of unpaid, underpaid and denied accounts from the appropriate third-party payer source ensuring that all assigned accounts are paid and/or resolved in a timely manner.
- Identifies and analyzes underpayments to determine the reasons for discrepancies and processes denials and appeals; examines claims to ensure payers are complying with contractual agreements.
- Address all inappropriate denials and underpayment by writing an effective and concise Provider Dispute Resolution/Appeal
- Communicates directly with payers to follow up on outstanding claims and resolve payment variances, responds to payer inquires and concerns, and works to develop and maintain positive relationship with payers.
- Focus attention on payers with all follow-up requirements, accounts with high dollar balances, aged accounts, denial trends to resolve denials in a timely and appropriate manner.
- Monitors and reviews denial reason codes and underpayments to identify root causes; works with payer and other areas of the revenue cycle if necessary to resolve issues. Notes denial trends and informs supervisor/manager of findings to mitigate future claim rejections.
- Maintains a thorough understanding of federal and state regulations as well as specific commercial payer requirements to promote compliant in billing and follow-up.
- Keep current on all commercial payer updates including contract languages, rates, policies, and payer updates/ changes. Keep Supervisor/Manager informed of any potential impact to current billing and reimbursement.
- Identifies compliance risk and proactively recognize and rectify any issues to prevent commercial payers’ audit.
- Collaborates with other departments to identify, correct, and resolve issues to reduce denials and improve collections.
- Utilize Government and Commercial regulatory guidelines for collection of outstanding accounts.
- Follow appropriate appeal process on denials, ensuring resolution.
- As appropriate, reviews, investigates and resolves missed payments or credit balances.
- Initiate appropriate adjustments, ensuring all necessary actions have been performed with the correct adjustment and amount.
- Responds to patient concerns and/or complaints on a routine basis and keeps departmental leaders apprised of recurring issues.
- Provide individual contribution to the overall team effort of achieving the department AR goal.
- Identify opportunities for system and process improvement and submit to management.
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 / GED (or higher)
- 1+ years of customer service experience
- 3+ years of experience in PB billing and follow-up/collection
- 6+ months exposure to the acquiring and/or managing of data to support a project
- EPIC experience
- Basic knowledge of medical terminology
- Knowledge with managed care contracts and appeal process
- Extensive experience and knowledge of PC application, including Microsoft Office Suite - Microsoft Word (create and edit correspondence), Microsoft Outlook (email and calendar management), Microsoft PowerPoint (ability to create and edit slides), and Microsoft Excel (ability to create, edit, and sort spreadsheets, basic analytical formulas (VLOOKUP, if)
- Ability to work full-time, Monday - Friday between 7:00AM - 4:00PM PST. It may be necessary, given the business need, to work occasional overtime.
- 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.
- Bachelor’s Degree (or higher)
- Background in a medical/healthcare setting
- Direct healthcare data collection experience
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military
Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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
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