Collections Representative - San Juan, PR

Taleo; San Juan (PR); On-site; USD 32,000 - 45,000; Full time

Job summary

UnitedHealth Group in San Juan, PR is seeking a Collections Representative to support billing and claims processing. You will review and resolve claims, interpret EOBs, and interact with payors to verify status and eligibility while maintaining PHI security.

The role emphasizes accuracy, efficient problem-solving, and collaboration with Patient Access and other back-end teams. This is a full-time position with a 40-hour work week and potential overtime.

Qualifications

• 6+ months of experience in collections, billing or healthcare claims.
• Proficiency with Windows PC applications and data entry.
• Experience with Microsoft Word, Outlook and Excel.
• Full-time schedule with varying hours; potential overtime/weekends.
• Professional proficiency in English and Spanish (bilingual).

Responsibilities

• Complies with departmental Business Rules and SOPs.
• Focuses on decreasing accounts receivable, increasing cash, and reducing bad debt.
• Interprets EOBs for follow-up action.
• Uses payer portals to verify eligibility and claim status.
• Reviews and resolves claims using main systems, including Epic.
• Monitors outstanding balances and ensures timely payments.
• Prepares invoices and reconciles with accounts receivable.
• Collaborates with Patient Access and back-end teams on claim errors and trends.
• Performs data entry and re-work for adjudication.
• Maintains secure access to payor portals.
• Handles multiple projects and ensures PHI compliance.
• Meets defined performance goals for efficiency, accuracy, quality, and attendance.

Skills

Collections/billing experience

Bilingual English/Spanish

MS Word

MS Excel

MS Outlook

Data entry

Tools

EPIC system

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Collections Representative - San Juan, PR (2391086)

Collections Representative - San Juan, PR - 2391086

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 resolutionReview 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.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

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