Hospital Bill Audit Eligibility and Research Associate

About the position If you are located within Mainland USA, you will have the flexibility to work remotely as you take on some tough challenges. Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The HBA Eligibility and Research Associate position is a member of the Post-Pay Eligibility & Research group within the Hospital Bill Audit (HBA) team and supports our auditors and audit process. The primary responsibility of the role is the perform pre-audit and post-audit analysis and research of claims and client contract information to determine eligibility of client claims for HBA audits and overpayment calculations. 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 of 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of on-the-job training. The hours of the training will be aligned with your schedule. 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.

Responsibilities

• Utilize payer claim systems, where applicable, to review and analyze claims to verify eligibility for HBA audit including determination and updating of the payment methodology, exclusions, and non-covered charges in Optum systems
• Utilize payer claim systems to review contracts between clients and providers to identify contractual rates and guidelines to determine payment accuracy
• Determine overpayment calculation and refund due from provider
• Document outcome of payment analysis and research in appropriate Optum and client payer systems approve or reject claims for audit based on analysis/research
• Complete annual client compliance training and maintain access to client systems
• Research and respond to operational inquiries
• Provide feedback on ineligible claims where needed
• Other duties as assigned

Requirements

• High School Diploma / GED
• Must be 18 years of age OR older
• 1+ years of experience in medical claims processing/billing/collections and /or contract analysis
• Understanding of payment methodology and the ability to calculate correct payment amounts for claims including, but not limited to percent of charge, stop loss, DRG, per diem, case rate
• Understanding of relevant privacy regulations (e.g., HIPAA)
• Proficient computer skills including Microsoft Office suite; Microsoft Word (ability to create, copy, edit, save, and send documents), Microsoft Excel (ability to create, copy, edit, save, and send spreadsheets) and Microsoft Outlook (email and calendar management)
• Ability to work full time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime
• Reside within Mainland USA
• 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.
• Attention to detail, organizational, problem solving and time management skills with flexibility to adjust to changing priorities
• Math skills; proficiency in the ability to apply proper payment methodologies and calculate payments
• Effective oral and written communication skills plus the ability to develop effective relationships with our internal and external customers
• Must be self-directed and able to prioritize own work; work with Specialists for more complex inquiries
• Confidence in ability to make decisions and support those decisions; work with senior team members on more complex evaluations
• Ability to learn to interpret client-provider contracts and extract necessary information to support the audit process
• Ability to learn and apply applicable federal, state, and local compliance regulations
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Benefits

• 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).
• No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.

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