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Senior Claims Specialist - El Segundo, United States - Optum
Description
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to startCaring. Connecting. Growing together.
R
esponsible for processing, auditing, and adjusting all facility medical claims, appeals and prepayment audits. Answers incoming telephone inquiries, and accurately and thoroughly documents problems and resolutions.
Troubleshoots claims that have been identified as needing additional work in the areas of eligibility, referral authorization and contracting or provider set-up.
Trains and assists other analysts with problem claims and escalated telephone calls.Primary Responsibilities:
Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer
Processes all types of medical claims and adjusts medical disputed claims (Professional and Facility) according to department, contract, and regulatory requirements
Performs prepayment audit on all types of medical claims (Professional and Facility) according to department, contract, and regulatory requirements
Answers telephone inquiries through the "Automated Call Distributor (ACD) Telephone System" as needed
Identifies individual provider needs and takes appropriate steps to satisfy those needs
Updates authorization information based on information obtained from provider
Troubleshoots problem claims to resolve provider issues or systematic issues
Verifies and interprets information in all vendor contracts to resolve issues
Trains analysts and monitors general office support functions as needed
Analyzes work processes, identifies areas needing improvements and initiates necessary steps to make changes
Participates in the continuous quality improvement of IMCS core business system
Follows unit procedures for performing call processing, claim adjustments and denials and references Policies and Procedures, job aides, provider contracts, and other reference materials to assure complete and accurate decisions
Uses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
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:
Commercial and/or Medicare Facility claims processing experience and knowledge of AB1455 regulations
2+ plus years of healthcare claims processing experience in a managed care environment with at least 2+ years working with facility provider disputes
Proven extensive knowledge of medical terminology, standard claims forms and facility billing coding, ability to read/interpret contracts, standard reference materials(PDR,
CPT, Revenue, HIPPS, ICD-10, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge
Proficiency with Microsoft Office to include Outlook, Excel, Word, etc.
Ability to train onsite in our El Segundo, CA office for 4-6 weeks
Preferred Qualifications:
Experience in an indemnity and/or HMO setting processing, auditing, or adjusting facility claims
Ability to process a variety of complex PDRs - Dialysis, Home Health, Skilled Nursing and Inpatient and Outpatient
California Residents Only:
The hourly range for California residents is $18.80 to $36.78 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.
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.#J-18808-Ljbffr
