Revenue Cycle AR Claims Specialist – Remote in Corvallis, OR

If you are located within commutable distance to our office location at 444 NW Elks Dr Corvallis, OR, you will have the flexibility to telecommute* (work from home) 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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Revenue Cycle Accounts Receivable Claims Specialist maintains up-to-date knowledge of insurance carriers’ rules, regulations, and contracts, serving as a liaison between patients and insurance carriers. Responsibilities include posting payments, adjustments, and status updates, while analyzing and testing new system modules and upgrades. This role conducts contract reviews to ensure payment accuracy through direct communication with payer provider representatives and ensures compliance with mandated provider roster requirements.

This position is full time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our shift schedules between the hours of 8:00am – 4:30pm local time. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer 2 – 3 weeks of paid training. The hours during training will be 8:00am to 4:30pm, Monday – Friday.  Training will be onsite in Corvallis, OR.

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

Primary Responsibilities:

• Will participate and maintain a culture within The Corvallis Clinic that is consistent with the content outlined in the Service and Behavioral Standards document. To this end, employees will be expected to read, have familiarity with, and embrace the principles contained within.
• Researches and resolves claims based on assignment, which could include contacting payers via phone or website, contacting practices, working across departments, writing appeals, and facilitating their submission, and all other activities that lead to the successful adjudication of eligible claims including but not limited to: 
  • Provides medical record documentation to insurance companies as requested. 
  • Files claims using all appropriate forms and attachments. • Communicates with insurances companies about insurance claims, denials, appeals and payments.
  • Research denied and improperly processed claims by contacting insurance companies or utilizing online payor portals to ensure proper processing and/or reprocessing of claims. Works directly with provider reps to escalate claims issues.
  • Resubmits denied and improperly processed claims to insurance payers in a timely manner. 
  • Creates, reviews, and works insurance aging reports to identify unpaid insurance claims, corrects any errors, and resubmits claims as needed to ensure timely and accurate payments are received. • Tasks appropriate staff while working vouchers for denials, $0 pay, and refunds. 
  • Communicates with practices and payers regarding claim denials and payer trends.
• Collaborates with Practice Management and the co-source model within the Electronic Health Record to ensure files are kept up to date; identifies and requests support where needed:
  • Analyzes and tests new system modules and upgrades, providing recommendations to management staff regarding necessary modifications, education, and training.
  • Works closely with physician credentialing to meet insurance and governmental mandates for updating insurance rosters quarterly. 
  • Responsible for maintaining and updating provider credentials, as well as updating insurance category classifications.
• Identifies root-causes of claim issues and proposes resolutions to ensure timely and appropriate payment. 
• Educates and communicates revenue cycle/financial information to patients, payers, co-workers, managers, and others as necessary to ensure accurate processes. 
• Identifies issues and or trends with payers, systems, or escalated account issues and provides suggestions for resolution to management. 
• Evaluates carrier and departmental information to determine data needed to be included in system tables.
• Completes tasks assigned through worklists, reports, projects, team goals and objectives. Meets productivity standards as set by management. 

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
• Must be 18 years of age OR older
• 2+ years of successful experience within medical billing office
• 1+ years of customer service experience
• Proficiency in Microsoft Office Suite; mainly Word and Excel
• Ability to work any of our shift schedules between the hours of 8:00am – 4:30pm local time, Monday – Friday. It may be necessary, given the business need, to work occasional overtime or weekends

Preferred Qualifications:

• Knowledge and understanding of insurance billing procedures.
• Knowledge of medical terminology, CPT, ICD-9 and ICD-10 coding
• Knowledge of finance and accounting, including insurance carrier billing
• Excellent oral and written communication skills
• Excellent customer service skills and ability to work with difficult or upset people
• Ability to collaborate well with providers and other staff
• Ability to work on multiple tasks simultaneously in a busy, demanding environment while maintaining quality of work

Telecommuting Requirements:

• Reside within commutable distance to our office location at 444 NW Elks Dr Corvallis, OR
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
• Should have fast and reliable internet, i.e., internet speed equal to or greater than 300 Mbps for download and 30 Mbps upload (please note that satellite internet service is not sufficient for this role)

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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