Payment Variance Specialist - National Remote

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Opportunities at Northern Light Health, in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, we have opportunities for you to make a difference in the lives of those we serve. As a statewide health care system in Maine, we work to personalize and streamline health care for our communities. If the place for you is at a large medical center, a rural community practice or home care, you will find it here. Join our compassionate culture, enjoy meaningful benefits, and discover the meaning behind: Caring. Connecting. Growing together.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 4:30pm EST. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of paid training. The hours during training will be 8:00am to 4:30pm, Monday - Friday. Training will be conducted virtually from your home.

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements
• Work closely by way of problem solving with peers and leaders to address payer underpayment and issues or changes that directly impact the accounts receivable
• Resolve assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with payer regulations and the department’s policy and procedures
• Take necessary AR adjustments in accordance with the department’s adjustment policy
• Meet or exceed the EMHS performance standards as it relates to quality and productivity
• Reviews historical payment information to determine accuracy of reimbursement
• Reviews potential Payment Variances and identifies true discrepancies
• Resolve payment disputes with payers by following appeal protocols and processes
• Request relevant information from appropriate revenue cycle and clinical departments as required by payer
• Advises management of Payment Variance issues which may require attention in a timely manner
• Ensure all functions related to underpayments support the team goals and objectives as well as EMHS’s financial performance objectives
• Thoroughly understand the department’s key performance indicators
• Maintain the knowledge of payer policies; complete AAHAM or other healthcare related webinars
• Attend internal education sessions to enhance or gain new skills
• Demonstrate departmental desire to provide community benefits by way of charitable events or contribution outside the four walls of the department

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:

• Must be 18 years or older
• 1+ years knowledge of medical terminology, Current Procedural Terminology (CPT), and International Classification of Disease (ICD)
• 1+ years experience with payer regulations, principles of accounting, reimbursement concepts and automated account receivable systems
• 1+ years experience working overpayments related to Government, Commercial, and self-pay payors. Exposure to working with applicable regulatory guidelines related but not limited to Medicare and Medicaid programs.
• Proficient with using Microsoft Office applications (Microsoft Excel, Microsoft Word, Microsoft PowerPoint, and Microsoft Outlook)
• Ability to work our normal business hours of 8:00am – 4:30pm EST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 1+ years of healthcare underpayments experience
• Experience with Northern Light Health patient accounting software

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:

• Possess strong problem-solving skills
• Excellent professional communication skills; both oral and written
• Customer oriented
• Demonstrated ability to work independently and collaboratively

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $16.54 - $32.55 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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