Optum · 11 hours ago
Collections Representative
United States
Full-time
Remote
Entry Level
$17.98/hr - $32.12/hr
1+ years expOptum is a part of the UnitedHealth Group family, focused on improving health data flow for a more connected system. The Collections Representative role involves collecting, reconciling, and managing accounts while ensuring compliance with regulations and providing excellent customer service to patients and payers.
EducationHealth CareMedicalPharmaceutical
Responsibilities
This position performs collecting, reconciliation, research, correspondence, and independent problem solving
Reconciles complex, multi-payment accounts
Submits appeal letters on underpaid claims as directed
Interprets payer contracts to determine if payment and adjustment is accurate
Reviews EOB's for denials, along with posting corrected adjustments in order to balance accounts
Identifies needs for process improvements and creating/enhancing processes in the PFS department
Promotes positive teamwork within department and among employees
Works with all hospital departments for proper coding and billing procedures
Follows all departmental, hospital, and regulatory policies and procedures, including HIPAA requirements
Utilizes top customer service skills with all customers: patients, government agencies and commercial insurances
Reconciles accounts on a daily basis to determine underpayment, overpayment or contractual adjustment correction
May be assigned to process payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment plans in an accurate and timely manner, meeting goals in work quality and productivity
Coordinates with other staff members and physician office staff as necessary ensure correct processing
Reconciles, balances, and pursues account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company's collection/self-pay policies to ensure maximum reimbursement
May be assigned to research payments, denials and/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors
Makes appeals and corrections as necessary
Builds strong working relationships with assigned business units, hospital departments or provider offices
Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems
Provides assistance to internal clients
Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues
Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers
Works as a member of the patient financial services team to achieve goals in days and dollars of outstanding accounts. Reduces Accounts Receivable balances
Uses systems to document and to provide statistical data, prepare issues list(s) and to communicate with payors accurately
Works independently under general supervision, following defined standards and procedures
Uses critical thinking skills to solve problems and reconcile accounts in a timely manner
External customers include all hospital patients, patient families and all third-party payers
Internal customers include facility medical records and patient financial services staff, attorneys, and central services staff members
Qualification
Required
High School Diploma / GED
Must be 18 years OR older
1+ years of hospital / facility collections experience, including follow‑up, appeals, and denied claims
1+ year of recent experience in follow-up with Medicare, Medicare Managed Care plans, Medi-Cal, or Medi-Cal Managed Care plans, including handling appeals and denials
Experience navigating within an insurance portal to work denied hospital claims to resolution
Experience reviewing and reading UB-04 claim forms
Proficient in Microsoft Office Suite - including Microsoft Word, Microsoft Excel, and Microsoft Outlook
Ability to work Monday - Friday, 8:00am - 5:00pm CST
Preferred
Experience with follow up on Medi-Cal or Medi-Cal Managed Care
Working knowledge of ICD-10 and CPT/HCPCS
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
H1B Sponsorship
Optum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (648)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
Company data provided by crunchbase