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SalaryOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best.Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work.SM
As a Clinical Claims Review RN, you will conduct hospital bill audits by reviewing the medical record against the itemized bill to verify services were provided and documented. A hospital bill audit identifies overcharges, undercharges, unbundled items and applies client specific policies to their reviews. There will be responsibility for scheduling on-site and off-site audits with flexibility to travel to a provider location when needed. This is a challenging and rewarding role for a RN with strong interpersonal and communication skills who likes independent, flexible, autonomous work. Should be detail-oriented and have strong clinical background to conduct on-site and off-site hospital bill audits.
Schedule: Monday - Friday, 8:00-5:00pm and travel to hospital locations for audit reviews within region
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Monitoring new case assignments
- Review medical records to verify services were provided and charges are accurate - Identify overcharges, undercharges, and apply client specific policies
- Scheduling on-site and off-site reviews – work that is assigned, contact providers and schedule dates and times to perform onsite, travel onsite as needed and perform reviews
- Comply with HIPAA and other regulations regarding the confidentiality of patient information
- Ensuring charges are generated in the most cost-effective manner for the client
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
Required Qualifications:
- Associates Degree (or higher) in Nursing
- Active and unrestricted RN license in the state of residence
- 3+ years of RN experience in an acute hospital setting
- 1+ year of medical record review experience
- Intermediate level of proficiency with Microsoft Office applications, including Word, Excel, and Outlook
- Ability to travel to hospital locations within your region for audits
Preferred Qualifications:
- Bachelor's Degree in Nursing (BSN)
- Previous auditing experience as a nurse
- 2+ years of Medical Claims Review experience
- Ability to read and interpret medical business correspondence, procedure manuals, and specific plan documents.
- CPT & ICD-10 familiarity
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.
#RPO, #Green
