Remote Insurance Follow-Up & Appeals Specialist

UnitedHealth Group; Las Vegas (NV); Remote; USD 25,000 - 44,000; Full time

Benefits offered by this job

Comprehensive benefits package

Remote work options

Job summary

UnitedHealth Group's Optum division is hiring an Insurance Follow Up Representative to work remotely within Pacific or Mountain Time zones. You will focus on obtaining payment on outstanding claims, resolving denials, and processing appeals to ensure timely reimbursement for services provided.

The role requires a High School Diploma or GED, 2+ years in insurance follow up, knowledge of EOB/ COB/remits, CPT and Diagnosis Coding, and basic anatomy.

Qualifications

• High School Diploma / GED or equivalent work experience
• 2+ years of experience in Insurance follow up (Denial follow up, appeals reconsiderations)
• Experience in appeals writing and processing
• 2+ years working knowledge of EOB, COB, Remits, and CMS 1500
• Working knowledge of CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy
• Ability to work full-time, Monday - Friday with PST/MST schedule

Responsibilities

• Contacts insurance carriers / patients regarding outstanding insurance claims to obtain proper payment based on EOB and / or contract modeling expectations.
• Knowledge of clinic operating policies to help in the identification of denial root causes.
• Prepares proper documentation for appeals to insurance carriers.
• Processes the appealing of claims reimbursed incorrectly by payors.
• Ensures all accounts are set up correctly in the computer using knowledge of AR software, understanding of eligibility requirements and use of the internet and payer portals.
• Has thorough knowledge of insurance carrier procedures and processes.
• Understands contract reimbursement rates for individual carriers / networks.
• Able to examine documents for accuracy and completeness including preparing records in accordance with detailed instructions.
• Must meet minimum production and quality standards as set by management.
• Responsible for managing their assigned worklist and following standard work to take actions to resolve no response claims, understand and respond to denied claims and effectively minimize over 90 aged claims and preventable adjustments.
• Able to examine documents for accuracy and completeness including preparing records in accordance with detailed instructions.
• Maintains Over 90 aging quality measures as determined by payer baselines and expectation.
• Other tasks as assigned

Skills

CPT & Diagnosis Coding

Medical Terminology

Basic Anatomy

EOB/COB/Remits

Education

High School Diploma / GED

Job description

UnitedHealth Group's Optum division is hiring an Insurance Follow Up Representative to work remotely within Pacific or Mountain Time zones. You will focus on obtaining payment on outstanding claims, resolving denials, and processing appeals to ensure timely reimbursement for services provided.

The role requires a High School Diploma or GED, 2+ years in insurance follow up, knowledge of EOB/ COB/remits, CPT and Diagnosis Coding, and basic anatomy.