Business Services Representative- Claims Specialist for Follow-up Team $1,500 Sign On Bonus ID-1456

The Business Services Representative functions as an integral member of the team and is responsible to ensure services provided to Optum patients are fully and correctly reimbursed by third-party carriers and patients in a timely manner, including the handling of paper and electronic correspondence and payments received for revenue cycle management. Focus on customer service when working with patients, clinical departments and carriers to ensure service questions and charge disputes are handled promptly and professionally. Demonstrate proficiency in job category skills through training, audit and certification to standard work. Flexible regarding work assignment based on certified skills and job categories to meet customer demand.   

The Business Services Representative is responsible for and not limited to:

The duties listed below are intended only as illustrations of the various types of work that may be performed.  The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment.

Follow Up/Appeals

• Process Follow up work queue claims to research, accept or appeal denials using work queue assistant functionality.   

• Review coding, reimbursement and billing requirements by health plan and properly interpret reason and remark code application.

• Process health plan correspondence to include documentation requests or appeal responses (OnBase)

• Use charge correction or edit to update CPT or apply modifier or diagnosis changes per Just Do It criteria.  

Preferred Experience and Credentials:

Note that these requirements are representative, but not all-inclusive, of the knowledge, skill, and ability required to perform this job.

• Knowledge: Working knowledge of CPT & Diagnosis Coding, Medical Terminology, and Basic Anatomy.

• Skills: Excellent interpersonal and team skills. Good Computer skills, minimum typing skill of 40 wpm.

• Abilities: Must have ability to work effectively to meet deadlines and assist others to do the same. Be competent in written and verbal communication. Have the demonstrated ability to work effectively with staff, patients, community, and external agencies.

• Education: High School Diploma/GED (preferred) or equivalent experience.

• Experience: Prior customer service and billing experience preferred.

• Certificate/License: None required, Certification in basic job category and one skill competency category expected after 6 months of job placement (including training, audit and certification). CPC Certification preferred.

Schedule: 40 hours a week. Monday-Friday 7:00am-3:30pm after initial training

Hybrid/Remote Work: Must work in-person in Everett, WA during initial training (approximately 4-6 weeks) and as needed.

Additional Requirements:

• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements.
• UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. 
• Candidates must be able to perform all essential job functions with or without reasonable accommodation.

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