Revenue Integrity Specialist
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Under limited supervision by the Manager, Revenue Integrity, this position is responsible for supporting our professional billing services. This includes compliant billing, denial analysis, reimbursement analysis, and monitoring of revenue compliance across multi-disciplinary teams.
You'll enjoy the flexibility to work remotely
- from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities :
Operational / Procedural ResponsibilitiesServes as an internal resource to clinical departments around professional charge capture and professional charge master updatesWorks with the revenue producing departments to ensure the ongoing coordinated consistency of the Chargemaster, including accurate descriptions, coding, additions, deletions, pricing and any other changesMonitors revenue compliance with clinical departments, evaluating professional charge capture processes for new and existing services, implementing best practicesParticipates in ongoing coordination and resolution of revenue issues as they arise ensuring the overall integrity of the charge capture processMonitors professional charging mechanisms and systems with in-depth knowledge of how orders and charges are entered and of the various system workflows to ensure proper generation of charges for billingAnalyzes reports to determine areas of improvement and determine appropriate plan of action by reviewing data and systems to target areas of improvementMaintain a timely turnaround of all requestsMaintain high productivity and quality with minimal supervisionYearly continuing education is requiredAbility to multi-task and work under aggressive deadlinesPossess effective time management skills to permit handling of a large workloadFinancial ResponsibilitiesPerforms analysisAbility to understand and analyze payer regulations and impact to the Professional Chargemaster on reimbursement and coding guidelinesDisseminates CMS updates to health care providers and clinical departments as they relate to billing, ensuring the necessary changes are implementedConducts internal reviews to improve revenue cycle, claims production and coding integrityMonitors compliance with corporate, federal, and state guidelines bringing forward changes, as applicable, while focusing on accuracy and revenue cycle integrityMaintains a solid working knowledge of the revenue cycle process to aid in the implementation of regulatory standards assuring appropriate and timely cash collectionTroubleshoot and resolve issues related to the revenue cycle by developing, presenting and implementing recommendationsResponsibilities for RelationshipsDevelop and maintain solid working relationships with internal and external customersCollaborate with managerial and supervisory staff to ensure compliant regulatory billing with correct coding on accountsPerforms similar or related duties as requested or directedPerforms other duties as requested and observed by supervisor or managerYou'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 :
5+ years of relevant experience e.g. patient billing and revenue cycle experience, experience in finance within a healthcare organization5+ years of experience CPT / HCPCS, UB-04 Revenue Coding, modifiers, billing regulations APC's, APG's and DRG's3+ years of experience with EpicProficient in the use of Microsoft Office Programs, including but not limited to Excel, Word, and AccessPreferred Qualifications :
5+ years of revenue cycle processes within a healthcare organization5+ years of financial related work experience5+ years of experience with CMS coding and compliance rules5+ clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or OncologySolid professional billing knowledgeDemonstrated familiarity with Epic - resolute and clinical appsDemonstrated ability to organize and assess various statistical and financial data and put forth conclusions based on data collected.Demonstrated ability to accomplish a defined scope of job performance through independent investigation, self-motivation, analytical and problem-solving techniquesAll 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). The salary for this role will range from $71,200 to $127,200 annually 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.
