UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Provider Claim Resolution Specialist - Green Bay, WI-314775
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.
The Provider Claim Resolution Specialist (PCRS) is responsible for efficiently navigating claim processing systems to complete all closed and denied, simple adjustments, and the majority of complex adjustments (out of scope high dollar and inpatient). Also, the PCRS will provide quality service to our Providers through real time and accurate resolution of closed and denied claims, simple adjustments and escalated claim issues.
Responsibilities:
- Perform all types of complex adjustments and closed, denied, and simple adjustments
- Meet Quality, Productivity and Attendance requirements
- Ensure Provider Satisfaction through:
- Maintaining accurate documentation in ORS
- Providing assistance to Providers with status updates
- Being responsible for any follow-up work needed for resolving and closing issues
- Identifying and resolving anticipated Provider issues to prevent future calls
- Maintain proficiency in all technical applications (technical skills and system knowledge)
- Comply with all current policies, procedures and workflows
Qualifications
Qualifications:
- 1 year of Claims, Office or Customer Service experience analyzing and solving customer problems
- Knowledge of medical claims billing ICD9, CPT, or HCPC codes
- Prior stable work experience
- High School Diploma, GED or 10 years of work experience
- Authorization to work in the United States
- Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Ability to remain focused and productive each day though tasks may be repetitive
- Effective communication skills
Work Environment:
- Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
Office environment
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. All candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
