Our office is located at N17 W24100 Riverwood Drive, Waukesha, WI. If you are located within commutable distance of the office, you may opt to work onsite, otherwise, you may enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Opportunities with ProHealth Care, part of the Optum family of businesses. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact and discover the meaning behind Caring. Connecting. Growing together.

This position is full-time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours in local time. It may be necessary, given the business need, to work occasional overtime. Our office is located at N17 W24100 Riverwood Drive, Waukesha, WI.

We offer 12 - 13 weeks of paid training. The hours of training will be based on your schedule or will be discussed on your first day of employment. Training will be conducted virtually from your home.

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

Primary Responsibilities:

Ensuring that coding and up front claim edits are resolved timely so claims can generate.
Accurately billing all patient claims to their specific insurance companies.
Conducting appropriate account a follow - up on unpaid, underpaid or overpaid balances.
Working all associated correspondence received.
Working collaboratively with patients and their insurance companies to secure payment due.
Collaborating with all hospital departments to ensure proper coding, authorization, reimbursement contract guidelines and approved medical billing standards are being followed.
Understanding place of service codes for professional billing. Understanding revenue codes, occurrence codes and bill types for hospital billing.
Understanding general medical terminology.
Demonstrates understanding of various denials including but not limited to medical necessity, experimental, drugs, and laboratory.
Demonstrates how to effectively appeal / overturn denials resulting in accurate reimbursement.
Possesses knowledge of payer policies and guidelines to successfully overturn denials.
Proactively contacts insurance companies on past due balances and utilizes critical thinking skills to determine the most expedient way to get claims paid; This could also include contacting provider representatives or contact specialists.
Identifies and brings forth to management, any denial trends related to procedures, coding, and physicians.
Obtains supporting documentation (clinical or hospital) necessary to resolve insurance company denials and submits information to the insurance company using appropriate appeal forms.
Monitor all assigned edit work lists, performing appropriate steps necessary to resolve all accounts in a timely manner; This includes timely responses for medical records requests, completion of additional information requests, etc., as requested by insurance companies.
Demonstrates excellent communication skills either verbally or written, by promptly and professionally answering or responding to phone calls, voicemail, in person or email.
Demonstrates effective personal time utilization, which includes appropriate levels of non - business - related talking, personal phone calls, breaks, lunch, tardiness and absenteeism.
Other 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 / GED OR equivalent years of working experience
Must be 18 years of age OR older
4+ years of medical billing experience
4+ years of follow - up and denials for hospital and professional claims
2+ years experience and working knowledge with UB04 OR HCFA 1500 claim forms
1+ years of Medicaid billing experience in hospital setting
1+ years of Medicaid billing experience in physician setting
Knowledge of medical terminology, including insurance terminology
Ability to navigate multiple programs and learn new and complex computer system applications
Ability to work necessary claim edits prior to the claims going out to the payers, for accuracy, coding, registration, and / OR payer guidelines
Ability to work any of our full-time (40 hours / week), 8-hour shift schedules during our normal business hours in local time from Monday – Friday. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

Ability to multi - task and to understand multiple products and multiple levels of benefits within each product
Ability to work autonomously
Ability to understand adjudication process in determining how a claim has been paid

Telecommuting Requirements:

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $16.54 - $32.55 per hour. 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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