Explore opportunities with Optum, in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together. This position is full-time, Monday - Friday. Employees are required to work during our normal business hours of 800am - 500pm CST. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of on-the-job training. The hours of training will be during our normal business hours. You ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities Ensuring that coding and up front claim edits are resolved timely so claims can generate Accurately billing all patient claims to their specific insurance companies Conducting appropriate account a follow - up on unpaid, underpaid or overpaid balances Working all associated correspondence received Working collaboratively with patients and their insurance companies to secure payment due Understanding place of service codes for professional billing Understanding general medical terminology Demonstrates understanding of various denials including but not limited to medical necessity, experimental, drugs, and laboratory Demonstrates how to effectively appeal / overturn denials resulting in accurate reimbursement Possesses knowledge of payer policies and guidelines to successfully overturn denials Proactively contacts insurance companies on past due balances and utilizes critical thinking skills to determine the most expedient way to get claims paid; This could also include contacting provider representatives or contact specialists Identifies and brings forth to management, any denial trends related to procedures, coding, and physicians Obtains supporting documentation necessary to resolve insurance company denials and submits information to the insurance company using appropriate appeal forms Monitor all assigned edit work lists, performing appropriate steps necessary to resolve all accounts in a timely manner; This includes timely responses for medical records requests, completion of additional information requests, etc., as requested by insurance companies Demonstrates excellent communication skills either verbally or written, by promptly and professionally answering or responding to phone calls, voicemail, or email Demonstrates effective personal time utilization, which includes appropriate levels of non - business - related talking, personal phone calls, breaks, lunch, tardiness and absenteeism 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 2 years of physician billing experience 2 years of denials experience for professional claims 2 years of experience and working knowledge with HCFA 1500 claim forms Knowledge of medical terminology, including insurance terminology Ability to work necessary claim edits prior to the claims going out to the payers, for accuracy, coding, registration, and / OR payer guidelines Ability to navigate multiple programs and learn new and complex computer system applications Ability to work Monday - Friday, during our normal business hours of 800am - 500pm CST Preferred Qualifications Ability to understand adjudication process in determining how a claim has been paid 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 Ability to multi-task and to understand multiple products and multiple levels of benefits within each product Ability to work autonomously All employees working remotely will be required to adhere to UnitedHealth Group s Telecommuter Policy The hourly range for this role is $16.88 to $33.22 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHea