Insurance Follow Up Representative

Insurance Follow Up Representative

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Business Services department is seeking an Insurance Follow Up Representative to join their team full-time. Candidate must be able to demonstrate knowledge of CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy. Working knowledge of EOB, COB, Remits and CMS 1500 and appeal writing and processing.

The Insurance Follow Up Representative serves the patients, clinicians, and staff of Optum by obtaining payment on outstanding receivables timely. Focus is upon resolving any issues that may be causing delay of payment, including contacting payers and using appropriate websites to determine claim status. Investigation and resolution of denied claims including identification of trends and payer behavior that is contributing to inaccurate or delayed reimbursement for services rendered by our providers.

Primary function is to overcome obstacles to ensure timely and accurate insurance payment, validation that insurance liability has been met prior to assigning patient liability. Research and identification of clinic and payer behavior and trends that may risk reimbursement, addressing those scenarios to mitigate unnecessary write offs / losses. Independently works directly with straight forward payer contracts and guidelines to obtain accurate payment of insurance claims. Easily resolving eligibility denials but needing increased support to resolve billing related denials. Performs follow up actions including correcting payer rejections, checking claim status, updating patient registration related items, writing / processing appeals, performing corrected claims, and rebilling claims as necessary to ensure claims are processing in a timely fashion; escalate issues as appropriate to leadership.

This position is full-time, Monday - Friday. Employees are required to have flexibility to work during our normal business hours of 7 : 00am - 3 : 30pm PST. It may be necessary, given the business need, to work occasional overtime.

We offer on-the-job training. The hours of the training will be aligned with your schedule (follows the same hours except 2 days when they will start at 8 : 00 AM) or will be discussed on your first day of employment.

Primary Responsibilities :

• Contacts insurance carriers / patients regarding outstanding insurance claims to obtain proper payment based on EOB and / or Experian contract modeling expectations
• Knowledge of clinic operating policies to help in the identification of denial root causes
• Prepares proper documentation for appeals to insurance carriers
• Processes the appealing of claims reimbursed incorrectly by payors
• Ensures all accounts are set - up correctly in the computer using knowledge of A / R software, understanding of eligibility requirements and use of the internet and payer portals
• Has thorough knowledge of insurance carrier procedures and processes
• Understands contract reimbursement rates for individual carriers / networks
• Able to examine documents for accuracy and completeness including preparing records in accordance with detailed instructions
• Must meet minimum production and quality standards as set by management
• Responsible for managing their assigned worklist and following standard work to take actions to resolve no response claims, understand and respond to denied claims and effectively minimize over 90 aged claims and preventable adjustments
• Able to examine documents for accuracy and completeness including preparing records in accordance with detailed instructions
• Maintains Over 90 aging quality measures as determined by payer baselines and expectation
• Other tasks 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 :

Preferred Qualifications :

Telecommuting Requirements :

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $17.74 - $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.