Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

The Payment Entry Specialist works under general supervision to perform payment entry duties involving settlement of patient accounts and related clerical activities including posting patient and third party payments and adjustments; and balancing daily batches. The Payment Entry Specialist is responsible for maintaining a positive working relationship with patients, staff and third parties; representation of the organization in a professional manner; and, keeping the assigned supervisor apprised of work product/projects status on a routine basis.

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

Primary Responsibilities:

• Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer
• Reviews encounter data forms for accuracy of CPT and ICD-10 codes, required modifiers, and other encounter data
• Prints insurance claim forms
• Maintains Claim Form log
• Performs electronic claims submission
• Maintains summary report notebooks and confirmation logs
• Reviews insurance claim forms for accuracy and completeness
• Makes necessary claims corrections
• Sorts and reviews payments received by the Business Office
• Calculates insurance contact adjustments
• Prepares payments for data entry according to Payment Calculation policies and procedures
• Applies knowledge of Medicare and Medic-Cal guidelines in reviewing claims to ensure appropriate use of modifiers and CPT/ICD-10 codes
• Corrects claims appearing on edit reports
• Maintains Edit Report binders
• Communicates trends to department supervisors
• Maintains working knowledge of general claims requirements and updates to ICD-10/CPT codes
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  

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 or equivalent experience
• 1+ years of working in a general clerical in a medical setting
• Ability to demonstrate solid proficiency using MS Suite and other systems
• Professional working knowledge of CPT & Diagnosis Coding, Medical Terminology, and basic Anatomy
  

Preferred Qualifications:

• CPC certificate
• 2+ years of medical billing and/or related job experience
• 1+ years of working in a healthcare setting
• Bilingual
  

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $16.00 to $23.13. 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.