Experienced Bilingual Collections Representative - Remote Opportunity in San Juan, PR, Utilizing Strong Communication and Problem-Solving Skills to Drive Financial Excellence in Healthcare

Introduction to Our Company and Industry

Optum, a leading global organization, is dedicated to delivering care aided by technology, helping millions of people live healthier lives. Our team's work directly improves health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. We pride ourselves on a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. By joining us, you will become part of a mission to advance health equity on a global scale, making a real impact on the communities we serve.

Job Overview

As a Collections Representative, you will play a critical role in creating a quality experience that impacts the financial well-being of our patients. Your expertise in problem-solving will be invaluable as you work to quickly identify, analyze, and resolve issues in a fast-paced environment. This role offers the chance to take your career to the next level, supporting teams by reviewing and resolving claims with accuracy and fairness. Your listening skills, emotional strength, and attention to detail will be essential in ensuring every claim receives a thorough and fair review.

Primary Responsibilities

• Comply with departmental Business Rules and Standard Operating Procedures to ensure consistency and quality in your work.
• Focus efforts on decreasing accounts receivable, increasing cash, and reducing bad debt to contribute to the financial health of our organization.
• Interpret explanations of benefits for appropriate follow-up action, utilizing your understanding of healthcare claims and billing processes.
• Utilize payer portals to verify eligibility, claim status, and obtain better claim insight information, demonstrating your ability to navigate complex systems efficiently.
• Work directly from our main system to review and resolve claims for accurate resolution, ensuring that all claims are processed correctly and in a timely manner.
• Review and research denied claims by navigating multiple systems to accurately capture data/information for accurate processing, showcasing your analytical and problem-solving skills.
• Monitor outstanding balances within accounts and take appropriate actions to ensure clients pay as billed, maintaining a high level of accuracy and attention to detail.
• Manage the preparation of invoices and complete reconciliation of billing with accounts receivable, ensuring that all financial transactions are accurately recorded and up-to-date.
• Communicate and collaborate with Patient Access or other back-end departments to ensure a clear understanding of claims errors/issues and trends, using clear and simple language to facilitate effective teamwork.
• Conduct data entry and re-work for adjudication of claims, demonstrating your proficiency in using computer applications and managing data accurately.
• Responsible for maintaining access to payor portals current and secure, adhering to the highest standards of data security and compliance.
• Work on multiple simultaneous projects as needed, showcasing your ability to multitask and prioritize tasks effectively in a fast-paced environment.
• Work with PHI standards and electronic health record access compliance, ensuring that all work is conducted in accordance with legal and regulatory requirements.
• Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, client satisfaction, and attendance, demonstrating your commitment to excellence and continuous improvement.

Essential Qualifications

To be successful in this role, you will need:

• 6 months of experience in collections, billing, or healthcare claims, providing a foundation in the principles and practices of healthcare finance.
• Demonstrated ability using computer and Windows PC applications, which includes strong keyboard and navigation skills and the ability to learn new computer programs, showcasing your adaptability and willingness to learn.
• Experience with Microsoft Tools: Microsoft Word (creating memos, writing), Microsoft Outlook (setting calendar appointments, email), and Microsoft Excel (creating/editing spreadsheets, filtering, navigating reports), highlighting your proficiency in using common business software applications.
• Ability to work 40 hours/week during standard business operating hours Monday - Friday from 8:00 am – 8:00 pm AST, with flexibility to work overtime or weekends as needed, demonstrating your commitment to meeting the demands of the role.
• Professional proficiency in both English and Spanish (bilingual), enabling you to communicate effectively with a diverse range of clients and colleagues.

Preferred Qualifications

While not required, the following qualifications are preferred:

• Certified Medical Coder, indicating a high level of expertise in medical coding and billing practices.
• Experience in accounts receivable, insurance, and/or healthcare, providing a deeper understanding of the financial aspects of healthcare delivery.
• Experience processing medical claims, demonstrating your familiarity with the claims process and your ability to work efficiently in this area.
• Experience working in a fast-paced environment, showcasing your ability to thrive in dynamic and challenging situations.
• Medical terminology acumen, enabling you to understand and communicate complex medical concepts effectively.
• Medicare/Medicaid knowledge, providing a foundation in the principles and practices of government-funded healthcare programs.

Career Growth Opportunities and Learning Benefits

At UnitedHealth Group, we are committed to helping our employees grow and develop in their careers. As a Collections Representative, you will have access to a range of training and development opportunities, including:

• Comprehensive new hire training to ensure you have the skills and knowledge needed to succeed in your role.
• Ongoing professional development opportunities to help you build your skills and advance in your career.
• Opportunities to work on special projects and initiatives, providing you with the chance to develop new skills and gain new experiences.
• A supportive and collaborative work environment, where you will be encouraged to share your ideas and contribute to the success of our team.

Work Environment and Company Culture

Our company culture is built on a foundation of diversity, inclusion, and respect for all employees. We believe that everyone deserves the opportunity to live their healthiest life, and we are committed to making a positive impact on the communities we serve. As a Collections Representative, you will be part of a team that is dedicated to:

• Advancing health equity and improving health outcomes for all individuals.
• Providing high-quality, patient-centered care that meets the unique needs of each individual.
• Fostering a culture of inclusion, respect, and empathy, where everyone feels valued and supported.
• Supporting the well-being and success of our employees, through comprehensive benefits, recognition programs, and opportunities for growth and development.

Compensation, Perks, and Benefits

We offer a competitive salary and a range of benefits, including:

• Comprehensive health insurance, including medical, dental, and vision coverage.
• 401(k) retirement savings plan, with company match.
• Paid time off, including vacation, sick leave, and holidays.
• Opportunities for professional development and career advancement.
• Recognition and reward programs, to recognize and reward your contributions to our team.

Conclusion

If you are a motivated and detail-oriented individual who is passionate about delivering high-quality patient care and making a positive impact on the communities we serve, we encourage you to apply for this exciting opportunity. As a Collections Representative, you will be part of a team that is dedicated to advancing health equity and improving health outcomes for all individuals. Don't miss this chance to take your career to the next level and make a real difference in the lives of others. Apply now to join our team and start making a positive impact today!