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　　The Insurance Follow Up Representative serves the patients, clinicians, and staff of Optum by obtaining payment on outstanding receivables timely. Focus is upon resolving any issues that may be causing delay of payment, including contacting payers and using appropriate websites to determine claim status. Investigation and resolution of denied claims including identification of trends and payer behavior that is contributing to inaccurate or delayed reimbursement for services rendered by our providers. Primary function is to overcome obstacles to ensure timely and accurate insurance payment, validation that insurance liability has been met prior to assigning patient liability. Research and identification of clinic and payer behavior and trends that may risk reimbursement, addressing those scenarios to mitigate unnecessary write offs/ losses.

　　Insurance Follow-up Representative is distinguished by the level of experience, span of payer knowledge and denial resolution expertise. Levels I and II positions are primarily that of processing, documenting, and securing accurate insurance claim payments under the guidance of the Supervisor. Levels III (Lead) positions are generally focused on more complex payer and denial scenarios. Leads also accountable for effective on-boarding, training and real time support of teammates.

　　Independently works directly with straight forward payer contracts and guidelines to obtain accurate payment of insurance claims. Easily resolving eligibility denials but needing increased support to resolve billing related denials

　　Performs follow up actions including correcting payer rejections, checking claim status, updating patient registration related items, and rebilling claims as necessary to ensure claims are processing in a timely fashion; escalate issues as appropriate to leadership.

　　Primary Responsibilities:

　　Contacts insurance carriers/patients regarding outstanding insurance claims to obtain proper payment based on EOB and/ or Experian contract modeling expectations. Knowledge of clinic operating policies to help in the identification of denial root causes Prepares proper documentation for appeals to insurance carriers Processes the appealing of claims reimbursed incorrectly by payors Ensures all accounts are set-up correctly in the computer using knowledge of A/R software, understanding of eligibility requirements and use of the internet and payer portals Has thorough knowledge of insurance carrier procedures and processes Understands contract reimbursement rates for individual carriers/networks Able to examine documents for accuracy and completeness including preparing records in accordance with detailed instructions Must meet minimum production and quality standards as set by management Managing their assigned worklist and following standard work to take actions to resolve no response claims, understand and respond to denied claims and effectively minimize over 90 aged claims and preventable adjustments Able to examine documents for accuracy and completeness including preparing records in accordance with detailed instructions Maintains Over 90 aging quality measures as determined by payer baselines and expectation

　　In addition to the above: Maintains payer or subject matter expertise, provides elbow to elbow support with teammates, training and information retention. Works under minimal supervision to perform various routine and complex tasks including payer/claim trends, escalations, and resolving high level system/payer/claim issues.

　　Additional responsibilities are distribution of work assignments, identification and documentation of payer trends and escalation as appropriate. Monitoring workflow/quality, audits, and recommendations for performance evaluations.

　　Could potentially be asked to participate in the hiring process, making recommendations to a Supervisor or Manager. Always promotes collaboration and team spirit to maximize group effectiveness, including offering assistance and encouragement to others. Projects a compassionate, and professional demeanor while dealing with patients, staff and all parties encountered.

　　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.

　　Years of post-high school education can be substituted/is equivalent to years of experience

　　Required Qualifications:

　　2+ years of medical insurance billing and/or follow up 1+ years Lead or Supervisor experience

　　Washington Residents Only: The hourly range for Washington residents is $16.00 to $31.44 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

　　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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

　　OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment