Authorization Pre-Billing Specialist

UnitedHealth Group; San Diego (CA); Remote; USD 28,000 - 50,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

Dental, Vision, Life & AD&D

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Voluntary Benefits

Job summary

UnitedHealth Group is seeking a Hospital Revenue Cycle Specialist to review patient accounts, verify insurance, and ensure accurate billing in collaboration with Coding, CDI, and Billing teams.

This fully remote role offers Mon-Fri 8-hour shifts, telecommuting within the U.S., and a comprehensive benefits package including PTO, medical, dental, vision, and 401(k). Pay ranges from $20.00 to $36.00 per hour depending on experience.

Qualifications

• 2+ years of hospital revenue cycle experience.
• 2+ years in: Patient Access, Financial Clearance, Insurance verification, authorization management, Hospital Billing, Claims Editing, Denials Prevention, or CDI collaboration.
• 2+ years of experience with Hospital patient accounting systems, claim editing and work queue management.
• Proficient with Microsoft Office products.
• Must be 18 years or older.

Responsibilities

• Review in patient and outpatient accounts prior to billing.
• Validate registration and demographic accuracy; verify insurance coverage and financial class.
• Confirm authorizations, referrals, and medical necessity requirements.
• Review charges, billing indicators, and account edits.
• Collaborate with Coding, CDI, Patient Access, Case Management, and Billing teams.
• Escalate high-dollar, complex, or at-risk accounts for resolution.
• Maintain regulatory and payer compliance standards.
• Support reduction of DNFB inventory and claim delays.

Skills

Revenue cycle

Patient access

Insurance verification

Authorization management

Coding (CDI) collaboration

Claim editing

Denials prevention

Hospital billing

Microsoft Office

Education

High School Diploma/GED

Tools

Hospital patient accounting systems

EHR systems

Payer portals

Claim editing software

Work queue management

Job description

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Schedule: Monday - Friday - 8:00 AM - 6:00 PM - 8 Hour Shifts - Looking for start times to be staggered to have coverage while the site is open.

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

Primary Responsibilities:

• Review in patient and outpatient accounts prior to billing
• Validate registration and demographic accuracy
• Verify insurance coverage and financial class assignment
• Confirm authorizations, referrals, and medical necessity requirements
• Review charges, billing indicators, and account edits
• Collaborate with Coding, Clinical Documentation Integrity (CDI), Patient Access, Case Management, and Billing teams to resolve discrepancies before claim release.
• Escalate high-dollar, complex, or at-risk accounts for resolution.
• Work with partnering departments (Financial Counseling, Scheduling, Financial Clearance, and clinical areas) to ensure all aspects of the patient's encounter are completed as needed
• Maintain regulatory and payer compliance standards
• Meets or exceeds audit accuracy standards. Works worklists and error reports timely, and proactively seeks assistance to resolve as needed
• Support reduction of DNFB (Discharge Not Final Billed) inventory and claim delays
• May perform other duties upon request

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success.Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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
• 2+ years of hospital revenue cycle experience
• 2+ years of experience in one or more of the following: Patient Access, Financial Clearance, Insurance verification, authorization management, Hospital Billing, Claims Editing, Denials Prevention, Coding (CDI) collaboration.
• 2+ years of experience with Hospital patient accounting systems, claim editing and work queue management
• Basic level of proficiency with Microsoft Office products
• Must be 18 years of age or older

Preferred Qualifications:

• Experience reviewing and resolving authorization-related billing edits, claim holds, and discrepancies prior to claim submission for acute care hospital related services.
• Strong working knowledge of commercial, Medicare Advantage, and Medicaid managed care authorization requirements and payer specific guidelines.
• Proficiency with electric health record (EHR) systems, patient accounting systems, payer portals, and authorization tracking tools.
• Certified Revenue Cycle Representative (CRCR or other relevant health care revenue cycle certification
• Strong knowledge of payer specific authorization requirements, coverage policies, and navigating payer portals.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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