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The Collections Representative is responsible for performing collections functions by interacting with various departments, insurance carriers, and patients while ensuring a good relationship. Positions in this function contact customers and/or health insurance plans to determine reason for payment delinquency, negotiate and advise on collection of overdue bills, and take appropriate action to recover overdue payments.
This is a hybrid position and will require two days (Tuesday and Thursday) onsite at the office located at: 5130 Sunforest Drive, Tampa, FL 33634.
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Primary Responsibilities:
- Consistently exhibits behavior and communication skills that demonstrate our company's commitment to superior customer service, including quality care, and concern with each and every internal and external customer
- Perform collection activities on assigned work files according to department procedures
- Gather relevant account information from internal stakeholders (e.g., coding staff, billing person) to gain understanding of customers' obligations
- Evaluate account information (e.g., number of invoices; date past due; previous payment history; type of product; different contact; billing addresses) to determine payment issues, root causes, and trends
- Identify account issues that need to be escalated to senior leadership or internal partners for resolution (e.g., system, credentialing, and claim formatting issues)
- Receive/make phone calls to customers using relevant systems (e.g., Anywhere Connect, Unity) to request payment for services and/or answer patient's questions regarding billing statements
- Gather/seek additional information from applicable systems to further investigate customers' concerns or complaints
- Communicate (e.g., emails; phone; written correspondence) potential solutions or available services to external customers
- Performs necessary follow-up to ensure timely resolution of appeals, obtain updated insurance information, identify, and correct billing errors, etc.
- Receive and/or process credit card payments and/or electronic funds transfers within applicable systems (e.g., Velocity)
- Transfer payment information to internal partners (e.g., Cash Posting Dept) to ensure payment is applied to customer accounts
- Maintain current working knowledge of CPT and ICD-10 codes, required modifiers and encounter data
- Maintains up-to-date information on Medicare and Medicaid laws, HCFA requirements, contractual arrangements, and other third-party payer requirements
- Record correspondence information (e.g., dates; action taken) within relevant collection systems (e.g., eClinical Works, Allscripts, Athena)
- Apply knowledge of third-party payer guidelines in reviewing denied claims to ensure appropriate use of modifiers and CPT/ICD-10 codes
- Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Perform additional duties as assigned
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.
Required Qualifications:
- High school diploma, G.E.D., or equivalent
- 1+ years of medical collections experience
- CPT and ICD-10 experience
- Experience in utilizing payer web portals
- Proficiency with Microsoft Office Suite, especially Excel
Preferred Qualifications:
- CPC, CCS, CMC, CPC-A or CCA Certification
- Experience in Allscripts, Athena, or E-Clinical Works
- Experience in medical collections and self-pay collections
- Computer experience (MSWord or other processing programs)
- HMO/managed care, Fee for Service, and Medicare plans experience
- Ability to use 10-key by touch
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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.