Healthcare isn’t just changing. It’s growing more complex every day. ICD-10 Coding replaces ICD-9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that’s what fueled these exciting new opportunities.
Who are we? Optum360. We’re a dynamic new partnership formed by Excela and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we’ll leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.
If you’re looking for a better place to use your passion, your ideas and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.
All of us have a short list of the things that make a job great. If your list includes being able to make a difference, count us in as your next place to work. UnitedHealth Group is a Fortune 6 leader in health care at a time when health care is evolving for everyone. Our billing teams are part of an important chain of events that impact the lives of our members in positive ways. Join this group and we’ll have an impact on you. Apply now and discover the exceptional training, support and opportunities to grow that you’d expect from a Fortune 6 leader.
What makes this a special challenge? For one, we want to create a quality experience for every person we serve. So the bar is high for accuracy, communications style and effectiveness. Also, you’ll need to be researching and resolving problems before, during and after calls within a high volume, demanding environment.
The Patient Service Representative - Outpatient is responsible for coordinating and maintaining a positive customer experience while performing pre-registration, registration, scheduling, and business office functions. Must possess excellent customer service skills. Be able to interact in a friendly, professional manner with a wide range of patients, operations staff, physicians, and other departments within the Excela Health system. Attention to detail and the ability to work well under pressure is essential. Also must be able to function effectively in an environment where it is necessary to perform several tasks simultaneously, and where interruptions are frequent.
Regular, consistent, on-site, and timely attendance.
Schedules patient appointments for designated departments
a. Schedules appointments utilizing scheduling software tools.
b. Provides testing instructions to assure smooth services
c. Secures authorization and referral if applicable.
Customer Focus. Assesses customers' needs and considers customer in all decision-making processes to ensure a positive customer experience.
a. Greets the customer in a polite and professional manner whether face-to-face or on the phone, determines needs and responds appropriately and courteously.
b. Responds to customer issues (intra-departmental, inter-departmental, and public) timely and to the satisfaction of the customer.
c. Identifies and performs appropriate action in situations where it is necessary to obtain appropriate documentation for proper advancement through the revenue cycle.
Communication. Provides constructive feedback and clearly expresses ideas.
a. Interviews patients and/or their representatives in order to obtain accurate demographic, insurance, and claim adjudication information in a timely, courteous, professional manner.
b. Updates system appropriately and accurately, ensuring appropriate signatures are obtained and required authorizations/certifications/medical necessity guidelines are met.
c. Communicates with management all issues that impact the accurate, timely and complete accomplishment of all assigned tasks.
d. Identifies and communicates to management recommendations for process improvement.
e. Displays dignity and respect in all interactions.
Initiative. Readily accepts and incorporates changes into daily activities.
a. Conform consistently to all system changes; including insurance payer regulations.
b. Possess functional knowledge of systems and the revenue cycle in order to adequately assist customers and reduce the unnecessary transfer of work flows.
c. Follows all department processes and policies as required and updated.
Motivation and Influencing. Influences and persuades others to build commitment to quality and a positive hospital experience.
a. Acts as a role model for peers by striving for excellence, displaying a positive attitude, and actively supporting the team concept.
b. Monitors and reports on individual productivity to assist in the evaluation of one's ability to organize and plan daily work in order to meet outcome-based criteria set by management.
c. Volunteers to work additional hours or offers to contribute to on-going projects/assignments outside the scope of their own specific functions.
Fiscal Accountability. Hold self-accountable for departmental processes in order to obtain maximum reimbursement for services and the successful flow of the revenue cycle.
a. Assures proper identification of patients presenting for services following the proper departmental procedures.
b. Maintains accuracy of insurance coverage and guidelines including not but limited to verifying coverage through online eligibility software/insurance web-sites/customer service phone lines; completing Medicare Secondary Questionnaire when required; verifying medical necessity and ABN processes; determining if necessary authorizations or referrals have been obtained; ensuring each order meets current published standards; etc.
c. Investigates and identifies patient-responsibility dollar amounts in order to successfully collect point-of-service payments when appropriate.
Charge posting where applicable when staff is not available timely.
This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease.
This opening is primarily Outpatient at Westmoreland Hospital (WH) - 532 W. Pittsburgh Street Greensburg, PA 15601
Part Time (20 hrs) - Mon-Sat 6a-6p, may include weekends/holidays. Will assist in ED as needed- variable hrs 24/7
High School Diploma / GED (or higher)
Knowledge of Payor / Insurance Benefits
Must be available to work 20 hrs - Mon-Sat 6a-6p, including weekends/holidays as needed. Will assist in ED as needed - variable hrs 24/7.
Knowledge of Medical Terminology
Minimum 1+ years of admissions, scheduling, or business office experience.
Proficient Keyboard Skills measured at 30 wpm
Basic working knowledge of computers and office equipment
Basic Math and Keyboard Proficiency
Excellent communication, interpersonal and organizational skills
Ability to communicate with all members of the health care team
Proficient oral and written communication skills
Ability to multi-task and prioritize assignments
Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.SM
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.
Keywords: patient services, ED, scheduling, insurance eligibility verification, Medicare, charge posting