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UnitedHealth Group Senior Billing Representative - Remote in Marlborough, MA in Marlborough, Massachusetts

If you are located within 30 miles of Marlborough, MA, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

Healthcare isn’t just changing. It’s growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that’s what fueled these exciting new opportunities.

Who are we? Optum360 . We’re a dynamic new partnership formed by Quest and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group , we’ll leverage our compassion, our talent, our resources, and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.

If you’re looking for a better place to use your passion, your ideas, and your desire to drive change, this is the place to be. It’s an opportunity to do your life's best work. SM

All of us have a short list of the things that make a job great. If your list includes being able to make a difference, count us in as your next place to work. UnitedHealth Group is a Fortune 5 company leader in health care at a time when health care is evolving for everyone. Our billing teams are part of an important chain of events that impact the lives of our members in positive ways. Join this group and we’ll have an impact on you. Apply now and discover the exceptional training, support, and opportunities to grow that you’d expect from a Fortune 5 company.

This position is full - time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime. Training will be conducted virtually from your home.

What we do defines who we are. Take a deeper look at how we're providing support during this global health crisis and search for a way you can get involved. View our Covid-19 Resources Page at:

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Manage and track all stages of the claims process for non-contracted and contracted payors

  • Generate accurate insurance claims in a timely manner

  • Proactively follow up on claim status

  • Review Explanation of Benefits statements and take appropriate action via verbal or written appeal to challenge low payments and various denials

  • Ensures claims are paid according to contractual agreements

  • Serve as a reimbursement resource for internal (client services, sales) and external customers (customers, payors, physicians)

  • Answer incoming calls and electronic mail regarding patient billing and insurance inquiries

  • Verifies eligibility, benefit information and prior authorization requirements or other pre-service review options

  • Follow-up on outstanding AR balances by utilizing system queues and reports

  • Identify payment trends that negatively impact accounts receivable by utilizing excel and other system generated reports

  • Resolve claim issues with third party payors and patients

  • Processing of incoming mail and correspondence

  • Prepare and review bad debt and revenue adjustments (credits, refunds, transfers, etc.) in accordance with established guidelines

  • Remains current on third-party coverage, reimbursement information and trends

  • Monitors payer policy activities on technology coverage and payment

  • Provide monthly AR report on assigned payors

  • Maintain high level of integrity and confidentiality / patient privacy (HIPAA)

What makes this a special challenge? For one, we want to create a quality experience for every person we serve. So, the bar is high for accuracy, communications style and effectiveness. Also, you’ll need to be researching and resolving problems before, during and after calls within a high volume, demanding environment.

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.

R equired Qualifications:

  • High School Diploma / GED (or higher)

  • 2+ years of billing experience with medical billing and insurance collections

  • Knowledge of and experience with ICD-10, HCPCS, and modifier coding

  • Understanding of Reimbursement, Health Care Plans, Claim Processing, Medical Terminology

  • Proficient in Microsoft Excel with the ability to complete basic formulas, manipulate spreadsheets, sort/filter functions, etc.

  • Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications

Preferred Qualifications:

  • Associate's Degree (or higher)

  • XIFIN experience

Telecommuting Requirements:

  • Reside within 30 miles of Marlborough, MA

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy

  • Ability to keep all company sensitive documents secure (if applicable)

  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

  • Ability to work well independently as well as part of a team

  • Analytical skills, prioritization skills, and time management skills

  • Outstanding interpersonal, verbal, and written communications skills

  • Ability to multi - task and to understand multiple products and multiple levels of benefits within each product

  • Must be flexible, able to effectively multi-task, and work effectively in a fast-paced, high volume work environment, dependable and possess the ability

Careers with Optum . Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged, and high-performing teams to help solve important challenges.

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.

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.