UnitedHealth Group Hospital Claims Examiner – Remote in El Segundo, California

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Position in this function supports claims administration which includes answering incoming telephone inquiries and accurately and thoroughly document problems and resolutions. Processes simple professional medical claims for payment denial, or referral for the appropriate payor, and troubleshoots claims that have been identified an needing additional work I the areas of eligibility referral/authorization, contracting and/or provider set-up. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards • Follows unit procedures for performing call processing, claim adjustments and details and references Policies and Procedures, job aides, provider contracts, and other reference materials to assure complete and accurate decisions • Answers telephone inquiries through the Automated Call Distributor (ACD) • Telephone System; updates authorization information based on information obtained from caller; and ensures the average call monitor score over the previous six months meets or exceeds quality standards • Troubleshoots claims that require an authorization; tracks progress of resolution of claims issues and routes resolved claims back to the appropriate claims resource • Processes simple HCFA claims and performs simple claims adjustments as needed • Identifies individual provider needs and takes appropriate steps to satisfy those needs • Participates in continuous quality improvement of IMCS core business system • Performs 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: • Experience in Hospital/Facility claims processing • Experience with revenue codes • Experience ICD-10 • Familiar with HMO guidelines • Knowledge of bolthires Office products • Knowledge of compliance related to the processing of claims • Ability to research and verify claim payment issues • Ability to work 8am -5pm PST hours Preferred Qualifications: • 1+ years of experience in an indemnity and/or HMO setting • Knowledge of all types of professional claims • Knowledge of medical terminology and pricing options • Knowledge of different sources of authorization documentations • Proven to be reliable, dependable, and punctual • Proven excellent customer service and telephone skills • Proven excellent verbal and written communication skills • Proven ability to work in an environment with fluctuating workloads • Proven ability to solve problem systematically, using sound business judgement • Proven ability to make decisions with every call and handle escalated issues • Proven ability to make decisions regarding escalation of referrals to Care Management • Proven ability to read and interpret all vendor contracts California, Colorado, Connecticut, Nevada, New Jersey , New York , Rhode Island , or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $18.80 to $36.78 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. • 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: 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. 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