Remote Pre-Billing & Authorization Specialist

Optum; United States; Remote; USD 28,000 - 50,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan

Dental, Vision, Life & AD&D

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Job summary

Optum is a global health services company delivering care enabled by technology to help patients receive the care, pharmacy benefits, data, and resources they need. This role supports the revenue cycle by reviewing patient accounts prior to billing, verifying insurance, validating demographics, and ensuring medical necessity and authorizations are in place.

You will collaborate with Coding, CDI, Patient Access, and Billing teams across the United States to resolve discrepancies before claim

Qualifications

• 2+ years of hospital revenue cycle experience.
• 2+ years of experience 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.
• Proficiency with Microsoft Office products.

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, 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 to ensure all aspects of the patient encounter are completed as needed.
• Maintain regulatory and payer compliance standards.
• Meets or exceeds audit accuracy standards; worklists and error reports timely; seek assistance to resolve as needed.
• Support reduction of DNFB inventory and claim delays.

Skills

Hospital revenue cycle

Patient access

Insurance verification

Microsoft Office

Communication

Education

High School Diploma/GED

Job description

Optum is a global health services company delivering care enabled by technology to help patients receive the care, pharmacy benefits, data, and resources they need. This role supports the revenue cycle by reviewing patient accounts prior to billing, verifying insurance, validating demographics, and ensuring medical necessity and authorizations are in place.

You will collaborate with Coding, CDI, Patient Access, and Billing teams across the United States to resolve discrepancies before claim