Payment Research Specialist

Overview

Unified is a nationwide community of providers, operations specialists and thought leaders who look for the greatest opportunities to impact every woman's health, at every stage of their journeys. We are unparalleled in our scale and ability to adapt to address unmet and underserved needs. Through 815 clinics, 23 IVF labs, nationwide telehealth capabilities and targeted case management, our 2,700 independent, affiliated providers deliver comprehensive women's health services and continuously work to implement methods and develop techniques or platforms that improve the healthcare experience. We remain focused on enabling the discovery of new ways for our affiliated providers to deliver the high-quality care experience women deserve, in the ways they most wish to receive it, and collaborate across our community to make our vision a reality.

This position is responsible for resolving claims issues within the Care Centers(CCs). The position is responsible for A/R denials, underpayments, payments not according to contractual agreements, and any unresolved claims issues that may arise directly from the Care Center. There is an expectation of consistent communication via telephone and/or email to multiple entities (internally & externally) to resolve these issues.

Responsibilities

• Processes "Unpostables Dashboard" (i.e., payment or RA missing or not clear) in Athena
• Processes "non" claim situations such as recoupment of payment for different CC's paid claims, incentives, etc.
• Record Incentive payments received
• BYOLB process "Download Non-Athena Remittance"
• Manages Payspan (pulling remits from payer sites)
  
  

Qualifications

• High school diploma or equivalent
• Minimum of 5 years' experience interpreting insurance explanation of benefits, plan benefits, and patient benefits/liability
• Minimum of 5 years' experience working with medical claims (HCFA 1500, UB04, UB92), insurance billing, payment posting, insurance collections, appeals, and medical records requirements/requests
• Must possess excellent customer service skills communicating logically and clearly (verbally and in writing)
• Experience and knowledge of insurance payer websites (e-appeals & verification of eligibility)
• Experience with Microsoft Office & proficiency in data entry
• Knowledge of Insurance guidelines and contracting information according to industry standards
• Knowledge of Medical Billing & Coding or Certification is a plus
• Knowledge of governmental insurance especially Medicare and Medicaid according to industry standards
• All other duties as assigned
  
  

We're here for you-both personally and professionally.

Our benefits are designed to support you and your family at every stage of life. From health and wellness to financial security and career growth, we offer a comprehensive package to help you thrive.

Here's a Look At What We Offer

• Health Coverage
  
  

Medical, dental, and vision plans, fertility benefits, and supplemental insurance options.

• Paid Time Off
  
  

Vacation, personal days, and paid holidays to help you recharge.

• Financial & Retirement Planning
  
  

401(k) with employer contribution, plus Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs).

• Income Protection
  
  

Short- and long-term disability, paid parental leave, basic life insurance, and optional additional coverage.

• Wellbeing Support
  
  

Employee Assistance Program, commuter benefits, pet insurance, and identity theft protection.

• Professional Development
  
  

Opportunities and resources to support your career growth.