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The AR Clerk Recovery & Enrollment Specialist denotes the payments due to patients, insurance companies, and other third-party payers for medical services. This person will be responsible for compiling, analyzing, and reporting data regarding performance and trends, including areas such as claims, denials, payments, and dollars spent on claims. Develop and oversee the implementation of billing and coding policies and procedures and establish and maintain quality control.
Position in this function is also responsible for the timely and accurate enrollment processing within multiple clearinghouses for both client and payer for the EDI-related file processing. Job duties include, but are not limited to, submitting enrollment applications through the clearinghouses, utilizing payer portals for EDI-related maintenance, working with other departments within Optum to keep up-to-date client W9s and bank letters, connection set up between the client and their clearinghouse, verifying all files are being transferred correctly and available for electronic processing by the Optum RCM cash teams.
*** This job is based in Las Vegas, NV where we work Hybrid - 3 days onsite and 2 days remote ***
- Positions in this function prepare and maintain accounts receivable records, including receipts, claims, and overdue invoices
- Applies all incoming cash receipts and wire payments to the appropriate general ledger accounts
- Computes interest charges, processes refunds, and related items
- Performs periodic and month-end balancing and reporting activities
- Verify and identify discrepancies by and resolve patients’ payment issues
- Resolves most questions and problems and refers only to the most complex issues at higher levels
- This position must maintain a high level of customer service, which includes calling patients and insurance companies when needed
- Can work with minimum supervision
- Can handle deadlines and a fast-paced environment work
- Daily handle recoupments, takeback posting, yearly escheat review, and process
- Refunds are processed for patients and insurance
- End-of-month credit refund posting in different PM systems
- Outstanding customer service to all external and internal contacts
- Develops and maintains positive relationships through effective and timely communication
- Takes initiative and action to promptly respond, resolve, and follow up regarding customer issues
- Maintain multiple payer portals for each client to ensure timely enrollment of EFTs (Electronic Funds Transfers) to the validated client bank account
- Maintain multiple payer site setups for each client to ensure timely enrollment for ERA delivery to the correct client clearinghouse
- Accuracy of information when completing all submitted enrollment forms that contain client banking data
- Utilizing and maintaining multiple client EFT & ERA setups for multiple payer websites
- Work from multiple client clearinghouses
- Maintain Administrative access to client-related information according to Optum’s Compliance standards and federal guidelines
- Enrollment submission follow-up
- Request and organize supporting documentation to accompany various provider enrollment applications from multiple departments
- Communicate to management all Medicare/ Medicaid/Tricare/HIS changes and federal payer enrollment requirements
- Other duties and special projects 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.
- High School Diploma, GED, or equivalent experience
- Medical Billing & Coding certification
- 2+ years of experience researching and following up credits for commercial, government, and self-pay patients
- 2+ years of experience in cash posting and reading/understanding EOBs
- 2+ years of experience enrolling EFT and ERAs for different payers
- 2+ years of experience in reconciliation and research accounts
- 1+ years of experience working in a clearinghouse software
- Demonstrate basic computer MS Office knowledge and skills
- Proven solid organization and analytical skills
- Proven substantial attention to detail
- 2+ years of experience with ZirMed® Claims or Waystar Clearinghouse software
- 2+ years of experience with TriZetto clearing house software - eCW
- 2+ years of experience with Payspan clearing house software - Allscripts
- 2+ years of experience with Change Healthcare software
- 2+ years of Medical Billing experience
Nevada Residents Only: The hourly range for Nevada residents is $16.00 to $23.44. 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: 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.