Join Optum as a Denials and Refund Management Specialist, where you'll help improve health outcomes by managing refund requests and analyzing commercial contracts. Enjoy a hybrid work environment with a supportive culture and opportunities for career development.
Key Responsibilities
Collect and resolve denied payments from insurance companies
Execute the denial appeals process including documentation and tracking
Research and resolve payer rejected/denied claims
Maintain data on types of claims denied and collaborate for improvements
Prepare and submit reports as required
Track recovery efforts using departmental tools
Provide feedback regarding denial reasons and outcomes
Draft professional appeal letters
Identify contract issues related to denials
Ensure all payer contact is documented in the appropriate software
Consistently meet productivity and quality standards
Required Qualifications
High School Diploma / GED
Must be 18 years of age or older
2+ years of experience with insurance follow-up and/or payment variance review
2+ years EPIC experience
2+ years hospital accounts billing follow up experience - not professional billing
2+ years of experience analyzing commercial contracts including interpreting commercial language
Ability to perform mathematical calculations
Keyboard by touch
Advanced experience and knowledge Microsoft Office
Must be able to work in the office at least one day a week
Ability to work full-time, Monday - Friday
Benefits & Perks
Comprehensive benefits packageIncentive and recognition programsEquity stock purchase401k contribution