[Hiring] Authorization Pre-Billing Specialist @UnitedHealth Group

Role Description

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits, and career development opportunities.

Schedule:

• Monday – Friday – 8:00 AM – 6:00 PM – 8 Hour Shifts
• Looking for start times to be staggered to have coverage while the site is open.

Location:

• Remote in AZ, CA, or NV

Primary 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, Clinical Documentation Integrity (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 (Financial Counseling, Scheduling, Financial Clearance, and clinical areas) to ensure all aspects of the patient’s encounter are completed as needed
• Maintain regulatory and payer compliance standards
• Meets or exceeds audit accuracy standards
• Works worklists and error reports timely, and proactively seeks assistance to resolve as needed
• Support reduction of DNFB (Discharge Not Final Billed) inventory and claim delays
• May perform other duties upon request

Qualifications

• High School Diploma/GED
• 2+ years of hospital revenue cycle experience
• 2+ years of experience in one or more of the following: Patient Access, Financial Clearance, Insurance verification, authorization management, Hospital Billing, Claims Editing, Denials Prevention, Coding (CDI) collaboration
• 2+ years of experience with Hospital patient accounting systems, claim editing and work queue management
• Basic level of proficiency with Microsoft Office products
• Must be 18 years of age or older

Requirements

• Experience reviewing and resolving authorization-related billing edits, claim holds, and discrepancies prior to claim submission for acute care hospital related services
• Strong working knowledge of commercial, Medicare Advantage, and Medicaid managed care authorization requirements and payer specific guidelines
• Proficiency with electric health record (EHR) systems, patient accounting systems, payer portals, and authorization tracking tools
• Certified Revenue Cycle Representative (CRCR or other relevant health care revenue cycle certification)
• Strong knowledge of payer specific authorization requirements, coverage policies, and navigating payer portals

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)