Billing and AR Lead Access and Reimbursement Specialist - National Remote

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 (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 9:00 am - 7:30 pm EST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of training. The hours of the training will be from 8:00 am - 5:00 pm EST.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Be knowledgeable on medical professional claim billing, stipulation to billing products, what plan specific criteria's must be followed to successfully receive reimbursement for the post service claim billed
• Collaborate with relevant internal and/or external stakeholders to resolve issues and obstacles regarding network / program / contract access
• Support efforts to gain access to payer landscape via agreements specific to patients or products
• Communicate with applicable stakeholders to provide updates regarding network and contract implementation
• Conduct medical billing of drugs, and the follow-up/collections for government and commercial payers
• Track and monitor processed claims, review, and follow to ensure payment, and rebill corrections as needed
• Responsible for reviewing & reconciling items including follow up on any claims or billing resolution.
• Receive billing issues/information (e.g., contract language; letter of agreement recognition; explanation of medical benefits) and gather relevant data to resolve
• Educate patients/payers on payment options, billing information (e.g., where to send payment, when invoices are due; information contained on invoices)
• Reconcile discrepancies identified within customer invoices/billing and reports
• Demonstrate understanding of business partners' operations to identify appropriate resources for support and information
• Generate and/or distribute reports and documentation (e.g., billing statements) to customers/payers
• Contact external customers/payers to keep them informed of outstanding balances and required payment, as appropriate
• Research and retrieve missing EOBs and payments to post them promptly
• Identify trends in billing and follow-up, be able to identify ways in which we can expedite resolution of insurance accounts and identify delays in processing
• Responsible for accurate and thorough action, follow up, and documentation of information in accordance with procedures
• Readiness to jump in and be an operator to ensure patients' needs are met
• Knowledgeable and proficient in Coding principles, including CPT and HCPCS
• Knowledgeable and proficient in Medical benefit structure of all major payer types including Medicare, Medicaid, and private commercial
• Other functions and duties, including those of varied scopes, assigned by leadership across all of Optum Frontier Therapies as needed to support the success of our business

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 OR equivalent work experience
• Must be 18 years of age OR older
• 4+ years of hands-on Medical Claims Processing OR Medical A/R OR Medical Billing experience with a pharmacy OR facility OR payor
• Advanced knowledge of medical billing and regulatory requirements
• Ability to work an 8-hour shift schedules during our normal business hours of 9:00 am - 7:30 pm EST from Monday - Friday including the flexibility to work occasional overtime based on business need

Preferred Qualifications:

• Specialty Pharmacy experience
• Familiarity with A/R and RCM
• Familiarity with payer network / contracting
• Certified through AAPC OR AHIMA
• Certificate (CPB OR Dual Certified [CPB and CPC])
• Current certifications with proof of certification with valid certification identification number
• Has been in a startup environment OR have been part of building out processes and guidelines

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:

• Ability to provide quality customer service
• Ability to manage more than one project OR task at a time
• Meet deadlines and proactively communicate roadblocks
• Speak, listen, and write in a clear, thorough, and timely manner using appropriate and effective communication tools and techniques.
• Willingness to learn and grow in the position
• Participate in continuous quality improvement activities
• Be a team player and collaborate across functions
• Knowledge of auditing concepts and principles
• Ability to use independent judgment and to manage and impart confidential information
• Strive for thoroughness and accuracy when completing tasks
• Ability to work independently
• Knowledge of Internet navigation and research
• Organization and problem-solving skills
• Oral and written communication skills

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