Hospital Bill Audit Eligibility and Research Associate
Phoenix, Arizona, United States · Remote OK
$18/hr–$32/hr
Entry level$7.6B raised
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Hospital Bill Audit Eligibility and Research Associate
The associate performs pre-audit and post-audit analysis of claims and client contracts to determine eligibility for hospital bill audits and overpayment calculations. They are responsible for documenting outcomes in payer systems and responding to operational inquiries while maintaining compliance with privacy regulations.
Requirements
Candidates must have a High School Diploma or GED and at least one year of experience in medical claims processing, billing, collections, or contract analysis. Proficiency in Microsoft Office and an understanding of payment methodologies and HIPAA regulations are required.
Full job description
This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. 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 Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7am - 6pm CST. It may be necessary, given the business need, to work occasional overtime.
This will be on the job training and the hours during training will be during normal business hours.
Primary 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
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
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, etc.
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 any of our 8-hour shift schedules during our normal business hours of 7:00am - 6:00pm CST, Monday – Friday
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
Soft Skills:
Requires attention to detail, organizational, problem solving and time management skills with flexibility to adjust to changing priorities
Strong 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
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
We are 340,000 colleagues in two distinct and complementary businesses working to help build a modern, high-performing health system through improved access, affordability, outcomes and experiences.
Optum delivers care aided by technology and data, empowering people, partners and providers with the guidance and tools they need to achieve better health. UnitedHealthcare offers a full range of health benefits, enabling affordable coverage, simplifying the health care experience and delivering access to high-quality care.
We work with governments, employers, partners and providers to care for 147 million people and share a vision of a value-based system of care that provides compassionate and equitable care.
At UnitedHealth Group, our mission calls us, our values guide us and our diverse culture connects us as we seek to improve care for the consumers we are privileged to serve and their communities.
Click below to search careers or join our social communities:
• Search & apply for careers at careers.unitedhealthgroup.com/
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More about UnitedHealth Group can be found at unitedhealthgroup.com/
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