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If you are in within commutable distance of Torrance, CA, you will have the flexibility to work from home and the office in this hybrid role* 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.

This function is responsible for medical and ancillary product premium billing. Positions in this function interact with customers gathering support data to ensure invoice accuracy and also work through specific billing discrepancies. Provide input to policies, systems, methods, and procedures for the effective management and control of the premium billing function. Educate customers regarding the availability of receiving invoices and remitting payments through online applications. Monitor outstanding balances and take appropriate actions to ensure clients pay as billed. Manage the preparation of invoices and complete reconciliation of billing with accounts receivables. May also include quality assurance and audit of billing activities. Note: Positions mainly responsible for more general A/R activities which do not include medical and ancillary premium billing activities can be found in the Accounts Receivable function in the Finance job family.

Job Scope and Guidelines:

• Owns output at task level.

• Work is generally limited to own function.

• Sets priorities for the team to ensure task completion.

• Coordinates work activities with other supervisors.

• Develops plans to meet short-term objectives.

• Identifies and resolves operational problems using defined processes, expertise and judgment.

• Decisions are guided by policies, procedures and business plan.

• Product, service or process decisions are most likely to impact individual employees and/or customers (internal or external).

This position is 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 6:00am - 6:00pm PST. It may be necessary, given the business need, to work occasional overtime.

Our office is located at 19191 S. VERMONT AVEN 7th floor Torrance, California. Employees will be required to work 1 or more days onsite and some days from home.

We offer 2 weeks of paid training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

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

Primary Responsibilities:

• Educate external customers/payers on payment options, billing information (e.g., where to send payment; when invoices are due; information contained on invoices), and/or services (e.g., eService; Invoice Inquiry), as appropriate

• 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

• Conduct training (e.g., on-line demonstration; ULearn; knowledge base; invoice inquiry) with internal and/or external customers/payers (e.g., new account managers; new sales staff; pricing teams) on how to access, review, and/or remit payment for invoices

• Collaborate with internal partners (e.g., brokers, account managers) and/or external customers/payers to resolve customer issues

• Create and/or distribute documentation to inform internal and/or external customers/payers of new processes, procedures, or general changes to billing operations

• Input information and/or determine appropriate medical codes from relevant resources (e.g., EMR; physician documentation) in order to generate claims for payment

• Ensure accurate processing and completion of denied claims

• Receive billing issues/information (e.g., enrollment; contract language; pricing; explanation of medical benefits) and gather relevant data to resolve

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

• Analyze relevant information to determine potential reasons for billing discrepancies

• Ensure/verify source data is valid for billing and that it will be submitted to correct payer

• Reconcile discrepancies identified within customer invoices/billing and reports

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

• Generate and/or distribute reports and documentation (e.g., billing statements) to external customers/payers to inform them of premium balances

• Perform queries on relevant systems (e.g., PeopleSoft; Access; Great Plains; CareTracker; Platinum; Micro Strategies; eCW) to gather data needed to analyze billing discrepancies and issues

• Review/resolve claim edits prior to submission

• Demonstrate understanding of relevant terminology (e.g., financial; medical) required for claims/billing

• Demonstrate understanding of relevant systems, tools, and/or software applications (e.g., Prime; ACIS; PeopleSoft; Great Plains; CPS Mainframe; UMR Web Portal; SharePoint; GPS; MS Office; Lotus Notes Databases; EMRs; Practice Management Systems; CareTracker; Platinum; Micro Strategies; eCW)

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

• Demonstrate and maintain understanding of and comply with billing policies and procedures

• Utilize results from billing resolutions to identify potential corrections/enhancements to billing systems, tools, or processes

• Analyze reports against existing billing data and make appropriate changes to ensure billing accuracy

• Review rates from internal teams (e.g., Underwriting; Sales; Implementation) to ensure accuracy before entering rates into applicable systems

• Generate data queries, reports, and/or research (e.g., member audits; bill vs. paid reports) needed to monitor customer accounts and balances

• Modify and/or create invoices (e.g., place in Excel format; summary level adjustments) as needed to meet specific customer requirements

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

• Create and/or distribute billing operational and performance reports to applicable stakeholders (e.g., senior leadership; clients)

• Make and/or submit requested changes to customers'/payers' accounts when applicable

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

• 4+ years of progressive experience in accounts receivable, including supervisory roles, medical terminology

• Experience in researching and resolving coding-related claim denials, including re-submission with corrected codes or additional documentation

• Proficiency in financial software (EPIC, Athena) and strong analytical skills

• Ability to lead a team, resolve billing issues, and ensure compliance with financial regulations

• Ability to identify and analyze CPC coding-related denials from insurance companies or third-party payers

• Collaboration with healthcare providers or coding specialists to rectify coding discrepancies and improve claim acceptance rates

• Ability to work any of our 8-hour shift schedules during our normal business hours of 6:00am - 6:00pm PST, Monday - Friday. It may be necessary, given the business need, to work occasional overtime

Telecommuting Requirements:

• Reside within commutable distance of Torrance, CA

• 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

Soft Skills:

• Excellent communication skills and a commitment to ethical standards

California Residents Only: The salary range for this is $48,300 - $94,500 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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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