Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Billing Representative reports to the Billing Manager and is responsible for performing medical billing functions and providing administrative support to the Billing and Collections department. Positions in this function interact with customers and ancillary departments gathering support data to ensure invoice accuracy and work through specific billing discrepancies. Manage the preparation of invoices and complete reconciliation of billing with accounts receivable. May also include quality assurance and audit of billing activities.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm, Monday – Friday (employees can start as early as 7:00am). It may be necessary, given the business need, to work occasional overtime. Employees are required to work some days onsite and some days from home.

We offer 1-3 weeks of on-the-job training. The hours during training will start at 7:30 am or 8:00 am from Monday – Friday.

If you are within commutable distance to the office at 5130 Sunforest Dr, Tampa, FL 33634, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

Primary Responsibilities:

• Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with 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 relationships 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/edit 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.

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
• 1+ years of related job experience
• CPT/ICD 10 codes experience
• CPC Certification
• Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm, Monday – Friday (employees can start as early as 7:00am). It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Previous coding experience
• CMC, CPC-A Certification
• HMO/managed care, Medicare experience
• Previous Allscripts, eCW, Athena, and/or RCX system experience
• PCP and Hospitalist billing and coding experience

Telecommuting Requirements:

• Reside within commutable distance to the office at 5130 Sunforest Dr, Tampa, FL 33634
• 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:

• Computer literate
• Microsoft Office skills
• Working knowledge of business billing office duties
• Working knowledge of Medicare, Medicaid, and Managed care
• Good verbal and written communication skills
• Organized and detail oriented
• Ability to work under time constraints

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

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: 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.

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