Collections Representative - San Juan, PR

UnitedHealth Group; San Juan (PR); On-site; USD 21,000 - 30,000; Full time

Job summary

UnitedHealth Group seeks a Collections/Billing Representative to help ensure accurate, fair review of claims and support patients' financial well-being.

You will analyze explanations of benefits, verify eligibility via payer portals, and resolve claims in a fast-paced environment as part of a full-time team in Puerto Rico.

Qualifications

• 6+ months of experience in collections, billing or healthcare claims
• Proficiency with Windows PC applications and MS Office
• Professional English and Spanish communication skills
• Strong attention to detail and problem-solving ability
• Experience with EPIC or healthcare claim systems preferred

Responsibilities

• Complies with departmental Business Rules and SOPs
• Focuses efforts on decreasing accounts receivable, increasing cash, and reducing bad debt
• Interprets explanations of benefits for follow up action
• Verifies eligibility and claim status via payer portals
• Reviews and resolves claims for accurate resolution
• Communicates with other departments to clarify claim errors and trends
• Meet performance goals for efficiency, accuracy, quality, and attendance

Skills

Bilingual English/Spanish

Customer service oriented

Analytical thinking

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

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.

As a Collections and/or Billing Representative, you'll play a critical role in creating a quality experience that impacts the financial well-being of our patients. You'll be the expert problem solver as you work to quickly identify, analyze, and resolve issues in a fast-paced environment. This is your chance to take your career to the next level as you support teams by reviewing and resolving claims. Bring your listening skills, emotional strength, and attention to detail as you work to ensure every claim has an accurate, fair, and thorough review.

Primary Responsibilities:

• Complies with departmental Business Rules and Standard Operating Procedures
• Focuses efforts on decreasing the accounts receivable, increasing cash, and/or reducing bad debt
• Interprets explanation of benefits for appropriate follow up action
• Utilizes payer portals to verify eligibility, claim status and/or to obtain better claim insight information
• Works directly from our main system to review and resolve claims for accurate resolution
• Works directly from our Epic main system to review and resolve claims for accurate resolution
• Review and research denied claims by navigating multiple systems, to accurately capture data/information for accurate processing
• Monitor outstanding balances within accounts and take appropriate actions to ensure clients pay as billed
• Manage the preparation of invoices and complete reconciliation of billing with accounts receivable
• Communicate and collaborate with Patient Access or other back-end departments to ensure clear understanding on claims errors/issues and trends, using clear and simple language
• Conduct data entry and re-work for adjudication of claims
• Responsible for maintaining access to payor portals current and secure
• Work on multiple simultaneous projects as needed
• Work with PHI standards, and electronic health record access compliance
• Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, client satisfaction and attendance
• This position is full-time (40 hours/week) with business operating hours operating from Monday - Friday from 8:00am - 8:00pm AST. It may be necessary, given the business need, to work occasional overtime and/or weekends or holidays
• If selected for this position, it is required that you successfully complete the UnitedHealth Group new hire training and demonstrate proficiency to continue in the role
• Complete outbound calls as needed to payors for claim status
• Other duties may apply

ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION

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:

• 6+ months of experience in collections, billing or healthcare claims
• Demonstrated ability using computer and Windows PC applications, which includes strong keyboard and navigation skills and ability to learn new computer programs
• Experience with Microsoft Tools: Microsoft Word (creating memos, writing), Microsoft Outlook (setting calendar appointments, email) and Microsoft Excel (creating/editing spreadsheets, filtering, navigating reports)
• This position is full-time (40 hours/week) with business operating hours operating from Monday - Friday from 7:00AM - 7:00PM. It may be necessary, given business need, to work occasional overtime and/or weekends or holidays. Alignment to daylight savings changes may apply.
• Professional proficiency in both English and Spanish (bilingual)

Preferred Qualifications:

• Certified Medical Coder
• EPIC system experience
• Experience in accounts receivable, insurance and/or healthcare
• Experience processing medical claims
• Experience working in a fast-paced environment
• Medical terminology acumen
• Medicare/Medicaid knowledge

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.