Insurance Follow Up Rep- Kelsey Seybold Admin Office

UnitedHealth Group; Pearland (TX); On-site; USD 25,000 - 44,000; Full time

Job summary

UnitedHealth Group partners with Kelsey-Seybold Clinic to hire an Insurance Follow-Up Representative responsible for physician billing and third-party receivables. The role requires researching payor portals, filing appeals, and negotiating resolutions while meeting deadlines and policies.

You will handle patient and payor inquiries, document actions in the EHR, and contribute to timely, accurate collection of over $1M in receivables in a fast-paced healthcare setting.

Qualifications

• High School diploma or GED from an accredited program.
• 3+ years in health care billing and collection using a health care computer system; or 2+ years with preferred education.
• Working knowledge of major third party payers and their websites.
• Basic PC and Internet literacy.
• Medical Terminology, CPT & ICD coding application.
• Interpreting Explanation of Benefits (EOBs) and physician billing statements.
• Proven analytical and mathematical ability.
• Proven excellent interpersonal communications skills and ability to communicate effectively both orally and in writing.
• Proven ability to handle a variety of tasks with speed, attention to detail and accuracy.

Responsibilities

• Works assigned queues, including web-based work files, within filing and appeal deadlines.
• Adjudicates rejected and unpaid claims; researches denied claims to obtain information and appeals appropriately.
• Meets established production and quality standards.
• Identifies payor reimbursement patterns and alerts management as needed.
• Provides routine workflow training to new employees; supports Level I staff in denials and appeals.
• Stays abreast of payor guidelines and shares information with management.
• Communicates with patients to explain financial liability and support payment plans.
• Other duties as assigned.

Skills

Interpersonal communication

Analytical ability

Attention to detail

Medical terminology

EOB interpretation

Education

High School diploma or GED

Associate degree in Business Administration or related field

Tools

Epic Professional

Job description

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

Position in this function is under the supervision of the Business Office Supervisor, the Insurance Follow-Up Representative is responsible for physician billing and collecting of third-party account receivables using their knowledge of medical software, the EHR, and multiple payors' insurance websites to research accounts, refile or appeal claims, submit additional medical documentation and track account status by monitoring and analyzing assigned unresolved third-party accounts. The Representative is responsible for an inventory of over a $1M in insurance receivables. They will initiate contacts and negotiate appropriate resolution (internal and external) as well as receive and resolve inquiries and correspondence from third parties and patients. The ability to analyze, audit, problem solve and reconcile an account is critical to this position. Conducts duties in accordance with industry federal and state billing guidelines and contractual obligations and in compliance with department policies and procedures. Must demonstrate dependability and an ability to work independently. Must be able to retain composure, meet deadlines, and appropriately analyze, research, and resolve problems in a fast-paced environment with constant work-related interruptions. Professionalism and courtesy are expected when communicating with external contacts and patients to explain patient financial liability, advises of non-coverage, process payments and payment plans, clarify Explanation of Benefits and statement of physician services. Exhibits exceptional customer skills to provide the patient with a positive service experience.

Primary Responsibilities

• Works assigned work queues, to include web-based work files, within filing and appeal deadlines
• Adjudicates rejected and unpaid claims in accordance with established departmental policies and procedures. Contacts insurance companies regarding unpaid or no reject claims. Researches denied claims to obtain necessary information, correct transactions as needed, and appeal appropriately
• Meets established production and quality standards
• Identifies payor reimbursement patterns and trends and alerts management on an as needed basis
• Provides routine workflow training to new employees. Works in conjunction with Level I employees, responding in areas of expertise in order to assist in denials, appeals and timely responses to accounts needing additional attention
• Maintains competency by staying abreast of assigned payor(s) guidelines and policies regarding reimbursement and shares this information with department management on an as-needed basis
• Communicates with patients through incoming and outgoing phone calls to explain patient financial liability, advises of non-coverage, process payments, clarifies explanation of benefits and statement of physician services. Sets up payment plans for services following department policies. Exhibits exceptional customer skills to provide the patient with a positive service experience
• Other duties as assigned

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 or GED from an accredited program
• 3+ years of current experience in a health care billing and collection environment or relevant health care setting using an accounting/health care computer system; or 2+ years of related experience with preferred education
• Working knowledge of major third party payers and their websites
• Basic PC and Internet literacy
• Medical Terminology, CPT & ICD coding application
• Interpreting Explanation of Benefits (EOB's), physician billing statements
• Proven good analytical and mathematical ability
• Proven excellent interpersonal communications skills and ability to communicate effectively both orally and in writing with patients, physicians, management, and third-party representatives
• Proven ability to handle a variety of tasks with speed, attention to detail and accuracy

Preferred Qualifications

• Associates degree in Business Administration or related field; or successful completion of Coding and Billing Certificate Program
• 5+ years experience in a health care billing and collection environment or relative health care setting using an accounting/health care computer system in area of specialty
• Epic Professional
• Billing experience as is an understanding of a diversity of insurance plans
• Epic Professional Billing
• Ability to access and retrieve information from the EHR

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 $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

OptumCare 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.

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