Senior Medical Billing Specialist

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 

Explore opportunities with American Health Network (AHN), part of the Optum family of businesses. Here, you'll be part of a team that offers quality, affordable care that's backed by a global organization, committed to improving the lives of those we serve. We operate in over 70 medical offices in Indiana and Ohio with 1,200 employees. Our markets are continuing to grow and we're looking for talented individuals who share our passion for quality care to join our team in provider or office positions.

As a health-focused organization, we will empower you with resources that support your work-life flexibility as well as your physical, emotional and financial well-being. This is an opportunity to join a team that helps people feel their best and a chance to discover the meaning behind Caring. Connecting. Growing together.

The Senior Biller supports American Health Network physician billing and the collection of third-party accounts receivable. Under the supervision of the Business Office Supervisor, this role independently researches and resolves complex or aging insurance accounts using medical billing systems, the electronic health record (EHR), and payer websites. The Senior Biller refiles and appeals claims, submits supporting medical documentation, reconciles account activity, and follows unresolved balances through final disposition. The role also serves as a knowledgeable resource to team members by sharing payer requirements, identifying recurring denial or workflow trends, and supporting consistent billing practices.

This position is full time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime. 

We offer weeks of paid training. The hours of training will be likely during normal schedule but my need to shift based on training availability.   

Primary Responsibilities:

• Manage a significant inventory of insurance receivables, including complex, high-dollar, aging, denied, and underpaid physician billing accounts
• Research account history, eligibility, benefits, coding, authorization, medical necessity, claim status, payment activity, contractual adjustments, and payer requirements to determine the appropriate resolution
• Refile corrected claims, prepare and submit appeals, provide additional medical documentation, and complete timely follow-up through final account resolution
• Analyze and reconcile Explanation of Benefits (EOB) information, remittance activity, payer correspondence, physician billing statements, and patient account balances
• Initiate contact with payers, patients, internal partners, and other third parties; negotiate or coordinate appropriate resolution within established authority and guidelines
• Respond to inquiries and correspondence from payers and patients with professionalism, accuracy, and courtesy
• Explain patient financial liability, non-coverage determinations, EOB information, and physician service statements; process payments and payment plans in accordance with established procedures
• Review account activity for accuracy and completeness, identify discrepancies or root causes, and take appropriate corrective action
• Work escalated or technically complex accounts and provide subject-matter guidance to billing team members as needed
• Support onboarding, peer coaching, and knowledge sharing related to payer websites, system workflows, account documentation, billing practices, and follow-up techniques
• Identify recurring denial, reimbursement, documentation, or workflow trends and communicate findings to the Business Office Supervisor for review and process improvement
• Maintain complete, accurate, and timely account notes and documentation in the applicable billing system and EHR
• Prioritize assigned work, meet productivity and quality expectations, and manage deadlines in a fast-paced environment with frequent work-related interruptions
• Perform duties in accordance with federal and state billing guidelines, payer contracts, industry requirements, and department policies and procedures
• Maintain confidentiality and protect patient and business information in accordance with applicable privacy and security requirements
• Demonstrate dependability, sound judgment, composure, attention to detail, and the ability to work independently
• Provide a positive service experience through effective communication and exceptional customer service
• Other 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 / GED OR equivalent work experience
• Must be 18 years of age OR older
• 3+ years of current experience in a health care billing and collections environment OR a relevant health care setting using an accounting OR health care computer system
• 3+ years of experience utilizing ICD-10-CM, CPT, and HCPCS codes
• 3+ years of experience researching and resolving complex insurance receivables, denials, underpayments, appeals, and aging accounts
• 3+ years of experience working with major third-party payers, insurance plans, payer websites, billing requirements, and timely filing rules
• 3+ years of experience demonstrating the ability to interpret EOBs, remittance information, physician billing statements, payer correspondence, and patient account activity
• Proficiency with basic PC applications, internet research, and health care billing systems
• Ability to work full time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 4:30 pm EST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 5+ years of current experience in a health care billing and collections environment OR a relevant health care setting using an accounting OR health care computer system
• Successful completion of a coding and billing certificate program
• Experience with Epic Professional Billing OR another Epic billing environment
• Experience with accessing and retrieving information from an EHR
• Advanced understanding of a variety of commercial, Medicare, Medicaid, managed care, workers compensation, OR other insurance plans, as applicable to the assigned inventory
• Experience serving as a resource, trainer, mentor, OR peer coach in a billing OR collections environment

Telecommuting Requirements:

• 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:

• Strong analytical, mathematical, auditing, reconciliation, problem-solving, and organizational skills
• Excellent verbal and written communication skills, with the ability to communicate effectively with patients, physicians, management, third-party representatives, and internal partners
• Ability to manage multiple priorities with speed, accuracy, attention to detail, and appropriate follow-through
• Ability to work independently, retain composure, meet deadlines, and adapt to frequent interruptions in a fast-paced work environment
• Demonstrated professionalism, dependability, sound judgment, and customer service skills

Physical and Mental Requirements: 

• Ability to sit for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to communicate effectively verbally and in writing
• Ability to use logical reasoning for simple and complex problem solving
• Ability to maintain attention to detail and accuracy while managing multiple priorities and frequent interruptions

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy  

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). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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. 

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.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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