Associate Collections Representative - National Remote

$33,280 - $58,802/Yr

Optum - Dallas, TX

Full-time

Remote - Dallas, TX

5,001-10,000 employees

Insurance Carriers and Related Activities

About the position

The Associate Collections Representative plays a crucial role in ensuring accurate reimbursement from third-party payers and resolving assigned accounts in a timely manner. This position involves systematic reviews of unpaid, underpaid, and denied accounts, as well as providing education to other staff when issues arise. The role requires flexibility to work various 8-hour shifts during normal business hours and may involve occasional overtime. The position is fully remote, allowing employees to telecommute from anywhere within the U.S.

Responsibilities

• Perform daily, systematic reviews of unpaid, underpaid and denied accounts from the appropriate third-party payer source ensuring that all assigned accounts are paid and/or resolved in a timely manner.
• Address all inappropriate denials and underpayment by writing an effective and concise Provider Dispute Resolution.
• Identify and analyze underpayments to determine the reasons for discrepancies and process denials and appeals; examine claims to ensure payers are complying with contractual agreements.
• Communicate directly with payers to follow up on outstanding claims and resolve payment variances, responding to payer inquiries and concerns, and work to develop and maintain positive relationships with payers.
• Focus attention on payers with complex follow-up requirements, accounts with high dollar balances, aged accounts, denial trends, and other advanced follow-up scenarios.
• Note denial trends and inform supervisor/manager of findings to mitigate future claim rejections.
• Maintain a thorough understanding of federal and state regulations as well as specific commercial payer requirements to promote compliance in billing and follow-up.
• Keep current on all commercial payer updates including contract languages, rates, policies and payer updates/changes.
• Keep Supervisor/Manager informed of any potential impact to current billing and reimbursement.
• Identify compliance risks and proactively recognize and rectify any issues to prevent commercial payer audits.
• Utilize Government and Commercial regulatory guidelines for collection of outstanding accounts.
• Follow appropriate appeal processes on denials, ensuring resolution.
• Review, investigate and resolve missed payments or credit balances as appropriate.
• Initiate appropriate adjustments, ensuring all necessary actions have been performed with the correct adjustment and amount.
• Respond to patient concerns and/or complaints on a routine basis and keep departmental leaders apprised of recurring issues.
• Provide individual contribution to the overall team effort of achieving the department AR goal.

Requirements

• High School Diploma / GED
• Must be 18 years of age or older
• 2+ years of experience in Physician Billing and follow-up/collection
• Knowledge of managed care contracts and appeal process
• Experience with and knowledge of personal computer applications, including Microsoft Office Suite (Microsoft Word, Microsoft Excel, Microsoft PowerPoint, and Microsoft Outlook)
• EPIC experience
• Basic knowledge of medical terminology
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 3:30pm PST, Monday - Friday.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution