Job Location: El Segundo, CA
Overview:
Responsible for performing routine and moderately complex Encounter issues under limited supervision in order to maintain and support our Edifices 837 submissions, processes and systems related to response files received from our Health plans. Interacts with Senior Analysts and Supervisor.
Essential Functions:
- Manage Encounter submissions to comply with CMS EDI edits to all Health Plans
- ANSI 837 knowledge inbound and outbound
- MSSQL Reporting Knowledge for Health Plan Acknowledgment Reporting
- Encounters day to day processing.
- Identifying trends and reoccurring errors
- Escalating with details and examples to Senior team members
- Manage the organizations encounter data to ensure efficient day-to-day operations.
- Maintain escalated issues in a centralized system for the purpose of documentation to improve productivity and efficiency.
- Edifecs management and optimization.
- Responsible for maintaining all front-end errors in edifecs.
- Responsible for trending any reoccurring errors and escalating to the appropriate team members.
- Follow through on responses and escalations that are not resolved in initial email contact.
- Creating a centralized area where escalations can be managed, documented, and resolved.
- Manage response files from all HCP health plans.
- Become well versed in the frequency of the file deliveries to insure there are no missing files.
- Manage and work response files as they are received. This will include updating and resubmitting encounters with invalid data.
- Monitoring the second response after an encounter has been resubmitted with corrected data.
- Strong communication skills with all health plans.
- Performs additional duties as assigned.
- Uses, protects, and discloses our patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Education:
- Minimum: High school diploma, G.E.D. or equivalent. Includes special certification required for special jobs.
- Preferred: College Degree
Experience:
- Minimum: Up to and including 1 year of experience.
- Preferred: 1 to 3 years of SQL experience.
- Preferred: 1 to 3 years of Healthcare EDI experience.
- Preferred: 1 to 3 years Technical Support
Knowledge, Skills, and Abilities
- Computer literate.
- Working knowledge of 10-key calculator.
- Working knowledge of general office duties.
- Working knowledge of contracted insurance plans.
- Good verbal and written communication skills. Ability to use correct English grammar and spelling.
- Customer-service oriented.
- Ability to maintain courteous and friendly demeanor when dealing with the public and co-workers.
- Task-oriented.
- Ability to work in a fast-paced team-oriented environment.
Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(SM)
Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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