Claims Recovery and Resolutions Representative - Frederick, MD
April 26, 2018
The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication.The Claims Recovery Services Team is a responsible for working directly with health care providers to coordinate recovery / collection of overpayments. The team reviews overpayment situations, resolve, and recover dollars for health plans, commercial customers, and government entities. This position handles overpaid claim inventory through telephone contact with the provider, which includes physician, facility, labs, etc. You'll have all the tools and backing you need to help manage and ensure adherence to compliance policies. All the while, you'll be building your career with a leader and reaching for the highest levels of performance as you do your life's best work.SMThis position is full-time (40 hours/week) Monday- Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (7:30-5:30). It may be necessary, given the business need, to work occasional overtime. Our office is located at 800 Oak Street, Frederick, MD 21703.Primary ResponsibilitiesMake outbound calls to providers to discuss and resolve outstanding overpayments (95% of your day can be on phones)With a focus on building a strong working rapport with the provider representatives to review and discuss overpayment situations and provide detailed explanations to the providers in both verbal and written formatEscalate recovery efforts through many avenues to progress and resolve the situationsStrive to meet and exceed quality production defined goals (calls/contacts), including a financial targetEnsure adherence to state and federal compliance policies, reimbursement policies and contract complianceComplete required documentation on all recovery efforts on a timely basis in the appropriate claims platformsPerform other duties as assignedThis is a challenging role with serious impact. You'll need to sort through complex situations to understand and clarify where errors happened or where they may continue to happen. It's a fast paced environment that takes focus, intensity and resilience.
Required QualificationsHigh school diploma or GED or equivalent work experience1+ Medical Claims, Professional Billing, and / or Collections1+ year of experience analyzing and solving customer problemsPreferred QualificationsBachelor's Degree Experience working in the health care industry Medical healthcare terminology a plus Experience using 2 or more of the following Claims Platforms: ODAR, UNET, COSMOS, CPW, ISET, NICE, FACETS, CSP, and / or Oxford UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.SMCareers 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.SMDiversity 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.Key words: Healthcare, health care, Managed Care, Claims, Customer Service, Claims Recovery, Frederick, call center
Internal Number: 764770
About UnitedHealth Group
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.