Billing and Prior Authorization Specialist

Optum NYNJ, is seeking a BillerPrior Authorization Specialist to join our team in Lake Success, NY.  Optum is a clinician-led care organization that is changing the way clinicians work and live.As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. Lake Success Rheumatology has an immediate opening for a friendly, patient focused and detailed oriented Billing and Prior Authorization Specialist to join our team. The Billing and Prior Authorization Specialist is responsible for the completion of set processes and protocols. Works cooperatively with all members of the care team to support the vision and mission of the organization, deliver excellent customer service and adhere to Lean processes. Supports the teams in meeting financial, clinical and service goals.Schedule: This is a 37.5-hour work week, Monday through Thursday between the hours of 9:00 am to 5:00 pm. Friday 8:00 am to 3:00 pm shift to be determined by the hiring manager upon hire.Location: 2 Ohio Drive, Suite 103 Lake Success, New York, 11042Primary Responsibilities:Load or update insurance information as neededKnowledge of Infusion scheduling by medication treatment plan based on standards of careFile and fax recordsAnswers incoming phone calls in a courteous and prompt manner; directs calls and takes messagesAbility to maintain a work queue list- complete any pending actions i.e. referrals, scheduling appointmentsConfirms and schedule appointmentsVerify eligibility and authorization and flag appointment accordinglyVerifies insurance coverage, benefits, and creates price estimates, reverifications as neededAbility to discuss with patients balances and co-paysSchedule appointments using approved scheduling guidelinesUse call processing and other applicable functionality in the EHR to take messages and communicate with cliniciansMonitor administrative tasks in the EHR and respond timelyAssist coworkers as needed to ensure smooth office operation and delivery of excellent service through teamworkDemonstrate respect for patients and Optum staff by presenting a friendly, courteous manner always and maintaining patient confidentialityManage claims denialInteract with customers to gather support data to ensure invoice accuracy and work through specific billing discrepanciesProvide input to policies, systems, methods and procedures for the effective management and control of the premium billing functionEducate customers regarding the availability of receiving invoices and remitting payments through online applicationsMonitor outstanding balances and take appropriate actions to ensure clients pay as billedManage the preparation of invoices and complete reconciliation of billing with accounts receivableKnowledge of diagnosis and CPT codesManage appeals and follow up with pharmacies and insurance companiesPerform other duties as assignedWhat are the reasons to consider working for UnitedHealth Group?  Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:Paid Time Off which you start to accrue with your first pay period plus 8 Paid HolidaysMedical Plan options along with participation in a Health Spending Account or a Health Saving accountDental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage401(k) Savings Plan, Employee Stock Purchase PlanEducation ReimbursementEmployee DiscountsEmployee Assistance ProgramEmployee Referral Bonus ProgramVoluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 DiplomaGED1+ years of computer proficiency experience in Microsoft Office1+ years of experience working in medical office position performing duties such as insurance verification, obtaining pre-authorization, reviewing claims for errors before submission and maintaining appropriate medication schedulesPreferred Qualifications:Experience working with an electronic health record (EPIC)Knowledge of medical terminologyKnowledge of CPT and diagnosis codes Soft Skills:Ability to work independently and maintain good judgment and accountability Demonstrated ability to work well with health care providers Strong organizational and time management skills Ability to multi-task and prioritize tasks to meet all deadlines Ability to be empathetic and kind towards patientsAbility to work well under pressure in a fast-paced environment Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others      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 $17.98 to $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable.     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.      #RPO #RED

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