Appeals and Audit Research RN
About The Position
Optum Insight is hiring an Appeals and Audit Research RN to coordinate its Recovery Audit Contractor (RAC) audit program and support compliant, effective responses to Medicare audits and payment reviews. The position works with teams across Health Information Management, Coding, Revenue Cycle, Case Management, Physicians, and Financial Services, tracking audits and appeals through final resolution and communicating findings and recommendations to executive leadership and other stakeholders. The role analyzes audit findings to identify trends, risks, and opportunities to improve the revenue cycle. It also develops process improvements using trend analysis and predictive modeling, maintains audit records and regulatory checklists, coordinates documentation and response deadlines, and develops internal education on audit readiness, documentation, coding, and compliance. The position may be performed remotely from anywhere within the U.S., subject to UnitedHealth Group’s Telecommuter Policy.
Requirements
- RN license in the state of residence, or BSN status.
- At least 3 years of experience performing healthcare audits, appeals, and discussions within a hospital or healthcare environment.
- At least 3 years of experience in medical coding, billing practices, reimbursement methodologies, and Medicare processes.
- At least 3 years of experience with appeals.
- Intermediate proficiency in Microsoft Office.
- Strong communication skills.
- Strong analytical, project management, reporting, and communication skills.
- Ability to identify trends, manage multiple deadlines, and lead cross-functional initiatives.
- Telecommuters must adhere to UnitedHealth Group’s Telecommuter Policy.
- Candidates must pass a drug test before beginning employment.
Responsibilities
- Coordinate the Recovery Audit Contractor (RAC) audit program to ensure compliance with regulatory requirements and organizational standards.
- Collaborate with Health Information Management, Coding, Revenue Cycle, Case Management, Physicians, and Financial Services departments.
- Review, respond to, track, and monitor Medicare audits and payment reviews through final resolution.
- Manage audit planning, scheduling, reporting, content management, and adherence to audit standards and procedures.
- Analyze RAC and payer audit findings to identify trends, risks, and opportunities for revenue cycle improvement.
- Create and implement process improvement initiatives using trend analysis and predictive modeling to reduce audit exposure and financial risk.
- Coordinate RAC requests, appeals, documentation submissions, and response timelines to meet payer deadlines.
- Track audit inventories and maintain accurate records of audit activities, outcomes, recoveries, and appeals.
- Update regulatory checklists for internal audit reviews.
- Develop and deliver internal education and training on audit readiness, documentation, coding, and compliance standards.
- Communicate audit findings, trends, and recommendations to executive leadership, including the CFO, and departmental stakeholders.
- Apply knowledge of medical coding, billing regulations, appeals processes, and Medicare requirements to support successful audit outcomes.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs, subject to eligibility requirements.
- Equity stock purchase, subject to eligibility requirements.
- 401(k) contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
