Senior Medical Billing Specialist - Remote, Complex Claims

UnitedHealthcare; Hartford (CT); Remote; USD 25,000 - 44,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Job summary

American Health Network (AHN), part of the Optum family, is seeking a Senior Biller for a nationwide remote role. You will support physician billing and third-party accounts receivable, resubmitting and appealing claims, and following up to final resolution within payer guidelines.

The position requires strong billing system knowledge, payer requirements, and ability to collaborate with team members and supervisors. Training is provided, with standard hours and potential overtime.

Qualifications

• High School Diploma / GED or equivalent work experience.
• 3+ years of current experience in a health care billing and collections environment OR a relevant health care setting using an accounting OR health care computer system.
• 3+ years of experience utilizing ICD-10-CM, CPT, and HCPCS codes.
• 3+ years of experience researching and resolving complex insurance receivables, denials, underpayments, appeals, and aging accounts.
• 3+ years of experience working with major third-party payers, insurance plans, payer websites, billing requirements, and timely filing rules.
• 3+ years of experience demonstrating the ability to interpret EOBs, remittance information, physician billing statements, payer correspondence, and patient account activity.

Responsibilities

• Manage a significant inventory of insurance receivables, including complex, high-dollar, aging, denied, and underpaid physician billing accounts.
• Research account history, eligibility, benefits, coding, authorization, medical necessity, claim status, payment activity, contractual adjustments, and payer requirements to determine the appropriate resolution.
• Refile corrected claims, prepare and submit appeals, provide additional medical documentation, and complete timely follow-up through final account resolution.
• Analyze and reconcile Explanation of Benefits (EOB) information, remittance activity, payer correspondence, physician billing statements, and patient account balances.
• Initiate contact with payers, patients, internal partners, and other third parties; negotiate or coordinate appropriate resolution within established authority and guidelines.
• Respond to inquiries and correspondence from payers and patients with professionalism, accuracy, and courtesy.
• Explain patient financial liability, non-coverage determinations, EOB information, and physician service statements; process payments and payment plans in accordance with established procedures.
• Review account activity for accuracy and completeness, identify discrepancies or root causes, and take appropriate corrective action.
• Work escalated or technically complex accounts and provide subject-matter guidance to billing team members as needed.
• Support onboarding, peer coaching, and knowledge sharing related to payer websites, system workflows, account documentation, billing practices, and follow-up techniques.
• Identify recurring denial, reimbursement, documentation, or workflow trends and communicate findings to the Business Office Supervisor for review and process improvement.
• Maintain complete, accurate, and timely account notes and documentation in the applicable billing system and EHR.
• Prioritize assigned work, meet productivity and quality expectations, and manage deadlines in a fast-paced environment with frequent work-related interruptions.
• Perform duties in accordance with federal and state billing guidelines, payer contracts, industry requirements, and department policies and procedures.
• Maintain confidentiality and protect patient and business information in accordance with applicable privacy and security requirements.
• Demonstrate dependability, sound judgment, composure, attention to detail, and the ability to work independently.
• Provide a positive service experience through effective communication and exceptional customer service.
• Other duties as assigned

Skills

Analytical skills

Mathematical skills

Auditing

Reconciliation

Problem solving

Organizational skills

Verbal communication

Written communication

Education

High School Diploma or GED

Tools

Epic Professional Billing

EHR systems

Job description

American Health Network (AHN), part of the Optum family, is seeking a Senior Biller for a nationwide remote role. You will support physician billing and third-party accounts receivable, resubmitting and appealing claims, and following up to final resolution within payer guidelines.

The position requires strong billing system knowledge, payer requirements, and ability to collaborate with team members and supervisors. Training is provided, with standard hours and potential overtime.