Associate Medical Director jobs in Sumter, SC

Opportunities with Colonial Healthcare, part of the Optum family of businesses. Join our team and advance your career within a leading primary care and specialty medical practice that prides itself on family-focused, patient-centric care. With over 25 years of experience, offices across Sumter, Columbia, Camden, and Manning, SC, and a commitment to reducing wait times and integrating cutting-edge medical advancements, we offer a supportive environment where you can grow professionally. Our dedication to improving the quality of life for our patients through coordinated care and advanced diagnostic services is unwavering. Be part of a network that values Caring. Connecting. Growing together.

If you are located in EST or CST time zones, you will have the flexibility to work remotely* as you take on some tough challenges.

  
Primary Responsibilities: 

• Reviews notes from encounters and codes them according to the documentation (assigns accurate CPT, HCPC and ICD-10 codes if provider assigns incorrectly)
• Posts charges when needed for services rendered
• Reviews chart documentation for quality purposes to ensure that provider coding and documentation is synchronous- provides communication of any abnormal findings to billing manager to review 
• Reviews CPT/ICD 10 codes assigned for procedures to make sure accurate before submitting claim or before appealing with insurance
• Requests diagnosis from physician’s 
• Queries providers for documentation updates
• Adds appropriate modifiers 
• Monitors the “ERA PAYER DENIED” work queue, amongst other work queues
• Responds to coding requests from internal and external customers, i.e., business office, physician office
• Introduces changes in procedure; CPT, HCPC and ICD-10 codes and educates staff on the use of new codes
• Advises and physicians and staff on medical coding as requested by department leadership
• Facilitate resolution of open receivables by review of coding, billing, contract agreements, and authorization terms
• Diagnose and report issues with regards to rejection and denial trends to management
• Maintain accurate documentation of claim follow up activities
• Address inquiries on customer service encounters to include, but not limited to process requests for adjustments, account type changes, guarantor merges, and transfers when necessary, according to guidelines
• Address insurance denials and underpayments, appealing and/or adjusting balances as appropriate and accurately billing the guarantor for patient responsibility
• Accurately enter patient demographics, guarantor, and coverage information into ECW system
• Accurately change filing order, ensure necessary adjustments are listed on account, distribute payments to correct service dates and request changes if needed
• Know and use standard business practices, keep abreast of all insurance and system changes, demonstrate excellent customer service that promotes patient, staff, and customer satisfaction, and reflects the values of Colonial Healthcare
• Attend meetings regarding assigned Payors, team/department updates, etc.
• Assist insurance companies/guarantors with questions regarding charges and balances
• Work with other departments to resolve issues affecting reimbursement
• Answer calls from patients, providers, insurance companies
• Other duties as assigned

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 or GED 
• 1 years of healthcare revenue cycle experience with focus on medical billing and Accounts Receivable follow-up experience 
• Expert knowledge of medical billing and insurance claim processing 
• Solid understanding of Payer contracts, appeals, and pertinent communications with insurance companies 
• Solid communication skills, both written and verbal 
• Located in EST or CST

  
Preferred Qualifications: 

• CPC-A or 1 years of medical/facility billing medical revenue cycle expertise 
• Experience with eCW, Waystar, and other pertinent systems

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for this role is $16.54 to $32.55 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.  
  
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

  
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.    
 
  
Diversity creates a healthier atmosphere: OptumCare is an 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.   
   
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 

efore beginning employment.