Revenue Cycle Skilled Nursing Facility (SNF) Insurance Specialist

Opportunities at Optum, in strategic partnership with Allina Health. As an Optum employee, you will provide support to the Allina Health account. 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 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.

This position will administer full cycle billing for the Skilled Nursing Facility (TRP) including Private Pay, Medicare, Managed Care and other third-party payer claims, authorizations, customer service and collections for the Courage Kenny Rehabilitation Institute. This position is responsible for verifying insurance coverage and skilled nursing facility benefits, submission of concurrent prior authorization requests, the preparation and submission of complete and accurate claims, and for timely and effective resolution and follow up on collections as well as customer service for the TRP clients and their families. This position will interface with clients, family members, therapy team, social services and admissions staff, as well as health plan case managers and/or contacts and various other facility departments.   

Our office is located at 3915 Golden Valley Rd, Golden Valley, MN 55422.

The schedule for this role will include 4 days remote and 1 day weekly onsite at the above listed location.

Primary Responsibilities:

• Verify eligibility and benefits of patient accounts
  • Complete eligibility query and SNF benefit verification using electronic resources or phone at notice to admit, monthly (Medicare/Medicaid), and/or anytime benefit status changes

  • Identify benefits via electronic resources/phone; interpret results and enter into Point Click Care

  • Complete extended benefit check when requested by Social Workers or Case Managers

• Obtain and track Prior Authorizations
  • Submit Prior Authorization requests for continued inpatient stay and/or ancillary therapy required based on payer, completing payer specific forms, gathering documentation as necessary

  • Monitor and track PA renewals due and responses

  • Notify team of PA denials and communicate financial impact to clients/family, providing cost estimates as applicable

• Funding/Coverage set-up, Point Click Care & Net Health
  • Maintain accurate client information and client funding information in Point Click Care and Net Health Ensure systems have compatible information so they can communicate with one another

• Ensure compliance on insurance claims through editing, review, filing, status, and follow-up
  • Review, correct and update claims based on edits to support accurate and compliant claims submission

  • Perform follow up on claims such as status checks, denials, appeals, corrections and records requests Pursue underpaid claims. Review and appeal denied claims to resolution

• Administer self-pay accounts
  • Review and pursue collection of unpaid self-pay/ private pay balances

  • Review monthly statements, perform outbound collection calls, send letters on past due accounts

  • Assist clients via phone and in-person with financial assistance information and payment options

• Provide customer service support
  • Perform Financial overview meeting with new admits as assigned, providing outline of payer benefits, out of pocket estimated costs

  • Greet patient in a respectful, warm, and professional manner by phone and in-person

  • Follow appropriate processes to provide accounts receivable support on patient’s financial account

• Partner with external departments and provide necessary support on SNF case work
  • Field questions, provide direction and assistance as needed to non-TRP departments located on the Golden Valley Campus who are providing services to the TRP client/patients

  • Partner with MES worker on patient status and updates for TRP Medicaid applications.

• Research and resolve credit balances
  • Research credit balances to issue refund and/or process replacement claims for recoupment of overpayments as necessary

• Perform other duties as assigned
  • Provide support to Admissions Teams regarding Payer Prior Authorization tools and resources, assisting with problem solving as needed

  • Analyze and review accounts to identify procedural inefficiencies and make recommendations to improvements to supervisor or manager

  • Train new employees on department specific processes

  • Develop and maintain procedures related to department processes

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

• 2+ years of experience in full cycle billing for Skilled Nursing Facilities, Home Health, or Hospital to include experience with Medicare (Part A and B), Medicaid, and primary and secondary Managed Care payers

• Proven experience and understanding of state, federal, third party, and private pay billing and reimbursement procedures and collection practices

• Proven solid customer service skills with an exceptional ability to listen and communicate to others

• Proficient with computers and Microsoft programs including Adobe PDF, Word, Excel, and Outlook

• Located within a commutable distance of Golden Valley, MN

• Must be fully available for onsite training Monday - Friday 7:30am - 4:00pm CST for onboarding

Preferred Qualifications:

• Experience with Point-Click-Care

• Proven ability to accurately interpret billing information to identify problems and collect appropriate data to provide resolution

• Proven ability to manage a variety of tasks, often with frequent interruption, switching from task-to-task

• Proven ability to collaborate in a team environment and be willing to assist other departments as needed

• Demonstrated ability to organize and prioritize the work effectively with minimal supervision

• Demonstrated ability to handle and manage financial payments. Comfortable discussing financial matters with patients and/or other financially responsible parties, including requesting payments as due

• Proven ability to develop rapport with a wide variety of customers in a short timeframe

• Demonstrated ability to work in multiple programs and systems

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

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 $20.00 to $35.72 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.

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