[Hiring] Hospital Bill Audit Eligibility and Research Associate @UnitedHealth Group

Role Description

The HBA Eligibility and Research Associate position is a member of the Post-Pay Eligibility & Research group within the Hospital Bill Audit (HBA) team and supports our auditors and audit process. The primary responsibility of the role is to perform pre-audit and post-audit analysis and research of claims and client contract information to determine eligibility of client claims for HBA audits and overpayment calculations.

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

We offer 4 weeks of paid on-the-job training and the hours during training will be 8:00 am - 5:00 pm local time, Monday - Friday.

Primary Responsibilities:

• Utilize payer claim systems, where applicable, to review and analyze claims to verify eligibility for HBA audit including determination and updating of the payment methodology, exclusions, and non-covered charges in Optum systems.
• Utilize payer claim systems to review contracts between clients and providers to identify contractual rates and guidelines to determine payment accuracy.
• Determine overpayment calculation and refund due from provider.
• Document outcome of payment analysis and research in appropriate Optum and client payer systems; approve or reject claims for audit based on analysis/research.
• Complete annual client compliance training and maintain access to client systems.
• Research and respond to operational inquiries.
• Provide feedback on ineligible claims where needed.
• Other duties as assigned.

Qualifications

• High School Diploma / GED.
• Must be 18 years of age OR older.
• 1+ years of experience in medical claims processing / billing / collections and / or contract analysis.
• Understanding of payment methodology and the ability to calculate correct payment amounts for claims including, but not limited to percent of charge, stop loss, DRG, per diem, case rate.
• Understanding of relevant privacy regulations (e.g., HIPAA).
• Proficient computer skills including Microsoft Office suite; Microsoft Word, Microsoft Excel, and Microsoft Outlook.
• Ability to work full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime.

Requirements

• Reside within Mainland USA.
• Ability to keep all company sensitive documents secure (if applicable).
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• 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

• Attention to detail, organizational, problem solving and time management skills with flexibility to adjust to changing priorities.
• Math skills; proficiency in the ability to apply proper payment methodologies and calculate payments.
• Effective oral and written communication skills plus the ability to develop effective relationships with our internal and external customers.
• Must be self-directed and able to prioritize own work; work with Specialists for more complex inquiries.
• Confidence in ability to make decisions and support those decisions; work with senior team members on more complex evaluations.
• Ability to learn to interpret client-provider contracts and extract necessary information to support the audit process.
• Ability to learn and apply applicable federal, state, and local compliance regulations.

Benefits

• Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
• In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• The hourly pay for this role will range from $17.98 - $32.12 per hour based on full-time employment.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.