Billing Representative - Hybrid in Tampa
UnitedHealth Group
- Tampa, FL
- Permanent
- Full-time
- Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer
- Represents the Company in a professional manner, following all Company policies and procedures
- Uses, protects, and discloses Optum Care patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Ability to establish and maintain effective and positive working relationship with staff and management
- Ensures the timely submission of primary and secondary claims
- Maintains current working knowledge of CPT and ICD 10 codes, required modifiers and encounter data
- Performs electronic claims submission
- Notifies management of issues arising from erroneous codes, missing information, and error/edits messages
- Analyze relevant information to determine potential reasons for billing discrepancies and changes
- Seek assistance from internal partners (e.g., Coding; Credentialing; Clinics; Contracting) and/or external stakeholders (e.g., individual customers/payers; brokers) to resolve billing issues
- Reviews insurance claim forms for accuracy and completeness. Makes necessary corrections
- Demonstrates and applies knowledge of Medicare and Medicaid guidelines in reviewing claims to ensure appropriate use of modifiers and CPT/ICD 10 codes
- Review medical documentation to confirm appropriateness of codes when necessary
- Corrects claims appearing on Edit Reports
- Communicates system and claim formatting issues to the IT department and Billing Manager
- Serves as a resource to Optum Care staff on general billing guidelines
- Demonstrate understanding of business partners' operations to identify appropriate resources for support and information
- Perform quality checks on data entries prior to submitting information to internal and/or external customers/payers/clients
- Inform customers/payers of billing problem/issue findings and resolution as appropriate
- Contact external customers/payers to keep them informed of outstanding balances and required payment, as appropriate
- Demonstrate and maintain understanding of state and federal regulatory requirements as they apply to billing operations (e.g., health-care reform; state surcharges; CMS)
- May conduct training (e.g., on-line demonstration; knowledge base; invoice inquiry) to co-workers (e.g., new staff members, collection/cash posting teams) on how to access, review, and/or submit claims for payments
- Must be dependable and well organized
- Performs additional duties as assigned
- High school diploma, G.E.D. or equivalent
- CMC, CPC-A Certification
- 1+ years of related job experience
- CPT/ICD 10 codes experience
- Coding experience
- HMO/managed care, Medicare experience
- Allscripts, eCW, Athena, and/or RCX system experience
- PCP and Hospitalist billing and coding experience
- Bilingual in English and Spanish