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The Billing Representative reports to the Billing Manager and is responsible for performing medical billing functions and provide administrative support to the Billing and Collections department. Positions in this function interact with customers and ancillary departments gathering support data to ensure invoice accuracy and work through specific billing discrepancies. Manage the preparation of invoices and complete reconciliation of billing with accounts receivables. May also include quality assurance and audit of billing activities.

This is a hybrid position and will require two days (Tuesday and Thursday) onsite at the office located at: 5130 Sunforest Drive, Tampa, FL 33634.

Primary Responsibilities:

• Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer

• Represents the Company in a professional manner, following all Company policies and procedures

• Uses, protects, and discloses Optum Care patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

• Ability to establish and maintain effective and positive working relationship with staff and management

• Ensures the timely submission of primary and secondary claims

• Maintains current working knowledge of CPT and ICD 10 codes, required modifiers and encounter data

• Performs electronic claims submission

• Notifies management of issues arising from erroneous codes, missing information, and error/edits messages

• Analyze relevant information to determine potential reasons for billing discrepancies and changes

• Seek assistance from internal partners (e.g., Coding; Credentialing; Clinics; Contracting) and/or external stakeholders (e.g., individual customers/payers; brokers) to resolve billing issues

• Reviews insurance claim forms for accuracy and completeness. Makes necessary corrections

• Demonstrates and applies knowledge of Medicare and Medicaid guidelines in reviewing claims to ensure appropriate use of modifiers and CPT/ICD 10 codes

• Review medical documentation to confirm appropriateness of codes when necessary

• Corrects claims appearing on Edit Reports

• Communicates system and claim formatting issues to the IT department and Billing Manager

• Serves as a resource to Optum Care staff on general billing guidelines

• Demonstrate understanding of business partners' operations to identify appropriate resources for support and information

• Perform quality checks on data entries prior to submitting information to internal and/or external customers/payers/clients

• Inform customers/payers of billing problem/issue findings and resolution as appropriate

• Contact external customers/payers to keep them informed of outstanding balances and required payment, as appropriate

• Demonstrate and maintain understanding of state and federal regulatory requirements as they apply to billing operations (e.g., health-care reform; state surcharges; CMS)

• May conduct training (e.g., on-line demonstration; knowledge base; invoice inquiry) to co-workers (e.g., new staff members, collection/cash posting teams) on how to access, review, and/or submit claims for payments

• Must be dependable and well organized

• Performs additional duties 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:

• High school diploma, G.E.D. or equivalent

• CMC, CPC-A Certification

• 1+ years of related job experience

• CPT/ICD 10 codes experience

Preferred Qualifications:

• Coding experience

• HMO/managed care, Medicare experience

• Allscripts, eCW, Athena, and/or RCX system experience

• PCP and Hospitalist billing and coding experience

• Bilingual in English and Spanish

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.