Reimbursement Associate - Marlborough, MA

    • Marlborough, MA

Position Description

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.SM

This position is essential to the Reimbursement department. Accurately maintains patient financial records by recording cash, adjustments, discounts, charges and credits. Audits patient financial records to resolve errors; monitors use and development of transaction codes and AR reports to achieve errorless interface with cross functional departments to ensure consistency with financial reporting. It is the responsibility of this individual to p erform in-depth evaluation and analysis using claims information and other sources of data. Supports the development of data analysis that involves high dollar amounts, sensitive issues, or that otherwise meet criteria for action based on reactive and proactive data analysis.

Primary Responsibilities:

  • Accurately posts payments, credits, adjustments and or denials to accounts
  • Review manual adjustments prior to posting for understanding of impact on accounts
  • Reconcile EFT / ERAs and resolves related issues
  • Provide strategic decision support by creating, analyzing and effectively communicating results
  • Provide analytical support for reimbursement operations
  • Manually post non electronic patient, client and insurance payments on a daily basis
  • EDI (Electronic Data Interface) file processing, download remit files from clearinghouse and insurance plan websites for auto-posting into billing system
  • Resolve EDI file edits which require manual intervention to process the file
  • Prepares End of Month reporting to reconcile monthly activity with Finance Department
  • Maintain payor databases in applicable operating systems
  • Monitor partial patient payments and takes appropriate action for accurate and timely patient statements
  • Maintains a working knowledge of insurance protocols and reimbursement charges (e.g. contracted rates)
  • Communicate overpayment / payment discrepancies to appropriate personnel in a timely manner for review/resolve
  • Subject to cross training and support for other departmental roles
  • Proficient in Microsoft applications ( Microsoft Excel, Microsoft Word)
  • Previous cash application and invoicing experience
  • Ability to manage multiple projects and meet deadlines, provide
  • Knowledge of third party payors (Contracted, Non - Contracted; Medicare, Medicaid, Client)
  • Respond to ad hoc data requests for Reimbursement Department
  • Manage projects around internal and external audit requests, documenting policies and procedures, and assisting in departmental / projects
  • Ensure the accurate and timely completion of all testing and analysis related to system maintenance, enhancements and upgrades for the Reimbursement Department
  • Responsible for the implementation of plan changes, new functionality, system configuration
  • Good communication skills / written and verbal
  • Performs additional tasks as required

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 / GED (or higher) or equivalent
  • A solid understanding of Reimbursement, Health Care Plans, Claim Processing, Medical Terminology
  • 2+ years of billing experience with medical billing and / or insurance collections preferred
  • Proven knowledge of and experience with ICD - 10, HCPCS, and modifier coding

Preferred Qualifications:
  • Associate's Degree (or higher)
  • XIFIN experience

Soft Skills:

  • Must be flexible, able to effectively multi - task, and work effectively in a fast-paced, high volume work environment, dependable and possess the ability to work well with independently as well as part of a team
  • Demonstrate strong computer and analytical skills, prioritization, and time management skills
  • Outstanding interpersonal, verbal, and written communications skills required

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

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.

Keywords: Billing, Marlborough, Massachusetts, MA

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