UnitedHealth Group Looking for Lead Medical Biller- Pharmacy – National Remote at Tampa, FL Full Time

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

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work.SM

Turn on the news on any night of the week and you’re likely to hear about the changes that are sweeping through our health care system. It’s dramatic. It’s positive. And it’s being led by companies like UnitedHealth Group. Now, you can take advantage of some of the best resources and tools in the world to help serve our members. You’ll play a leadership role in a high volume, focused and performance driven call center where the goal is always to connect with members and enhance the customer experience. This is no small opportunity.

This position is full-time (40 hours/week) Monday to Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 08:00am – 05:00pm.

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Knowledgeable and proficient in coding and billing principles, including CPT and HCPCS
• Knowledgeable and proficient in Medical and pharmacy benefit structure of all major payer types including Medicare, Medicaid, and private commercial
• Knowledgeable and proficient in Claims billing procedures of key payers as defined by plan
• Keeps current with existing treatment trends, treatment standards and updated indications related to assigned programs in order to complete medical billing claims
• Oversee the benefit investigation of medical coverage specific to drug coverage, the medical billing of drugs, and the follow-up/collections for government and special term payers.
• Complete a benefits investigation to verify ability to bill the patients’ medical coverage, obtain what the drug coverage is a patient under their plan, what the stipulations to billing the drug is, what plan specific criteria’s must be followed to successfully receive reimbursement for the post service claim billed
• Track and monitor processed claims, review, and follow to ensure payment, and rebill corrections as needed
• Responsible for reviewing & reconciling items monthly including follow up on any claims or billing resolution.
• Manage claim denial and appeal resolutions based on payer rules and guidelines
• Research and retrieve missing EOBs and payments to post them promptly.
• Managing Government payer follow up and working with Finance for account reconciliations
• Current knowledge and understanding of provider-based and government billing regulations
• Identify trends in billing and follow-up, be able to identify ways in which we can expedite resolution of insurance accounts and identify delays in processing.
• Understand and perform patient management, able to accurately upload and prioritize all the payment support documents and other documentation
• Coordinates with board licensed healthcare professionals including but not limited to nurses, pharmacists, or supervised pharmacy interns for information needed to process claims
• Maintains a working knowledge of program guidelines, FAQ’s, products, and therapeutic areas related to assigned programs.
• Responsible for reviewing, interpreting, and reacting to data provided by clients and customers.
• Follows up with medical plans, pharmacy plans and third-party financial assistance organizations for general information, status updates and determination details within specified timeframes
• Accurately document all customer communications in an appropriate and professional manner within specified timeframes.
• Communicate customer statuses to the appropriate parties at specified intervals or as needed.
• Resolve customer issues through basic troubleshooting and escalate potential problems or issues that require management’s attention in a timely manner.
• Communicate with insurances, patients, and government institutions to request payment support documentation and follow-up or financial hardship plans.
• Responsible for maintaining the daily accounts and follow-up work lists within the department while maintaining the organization’s productivity standards.
• Process, and maintain, within expectation, all correspondence received from patients and insurance companies as it pertains to correct and timely billing of claims, and receipt of payment.
• Completes all the duties associated with OFT or as assigned by Access & Reimbursement leadership

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 higher)
• 3+ years of hands-on Medical Claims Processing or Medical Billing/Coding experience with a hospital, medical or health service provider, PBM or payor
• 2+ years of leadership experience, including training, and supporting team members
• Advanced knowledge of medical coding and billing systems and regulatory requirements
• Medical Terminology knowledge through on-the-job experience or education

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

• Certified through AAPC or AHIMA
• Certificate (CPB or Dual Certified [CPB & CPC])
• Current coding certifications with proof of certification with valid certification identification number

Soft Skills:

• Has been in a startup environment or have been part of building out processes and guidelines
• Demonstrated ability to provide quality customer service
• Ability to manage more than one project or task at a time
• Meet deadlines and proactively communicate roadblocks
• Speak, listen, and write in a clear, thorough, and timely manner using appropriate and effective communication tools and techniques Willingness to learn and grow in the position
• Participate in continuous quality improvement activities
• Be a team player and collaborate across functions
• Good knowledge of auditing concepts and principles
• Ability to use independent judgment and to manage and impart confidential information
• Strive for thoroughness and accuracy when completing tasks
• Ability to work independently
• Strong knowledge of Internet navigation and research
• Excellent organization and problem-solving skills
• Strong oral and written communication skills

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies required all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $21.68 – $38.56. The salary range for Connecticut / Nevada / New York City residents is $23.94 – $42.40. 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.

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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