Clinical Claim Review LPN - Remote
About The Position
Optum 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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Function is responsible for retrospective medical claim review of inpatient hospital claims, following Medicare/Medicaid guidelines. Positions in this function includes those responsible for initial triage of facility claims. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Requirements
- Undergraduate degree or equivalent experience
- Current unrestricted LPN licensure in applicable state
- Proficient with computer, knowledgeable with Microsoft Office (Outlook, Excel, Word)
- Proven good written and verbal communication skills
- Proven to work with minimal guidance
- Proven ability to multi-task, manage change in a production environment
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Nice To Haves
- Medical coding experience
- Claim’s experience
- Knowledge of the various platforms (Cosmos, Facets, NICE, Macess, ORS)
- Knowledge of various applications (ECAA, PEGA, Doc360, iDRS, ORS, PCOMM)
- Proven solid attention to detail and maintaining quality focus (Soft Skill) and Multi-tasking
- Proven ability to learn quickly, and cross-train in multiple platforms
Responsibilities
- Sets up/documents/templates/triages medical records for Medical Claims Review
- Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance
- Interpreting medical records and billed codes
- Processes correspondence letters as needed
- Preparing reconsideration reviews for the Medical Director
- Communication via online routing system
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
