Clinical Claims Review RN - National Remote

UnitedHealth Group•Tampa, FL

1d•$29 - $52•Remote

About The Position

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. 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 a responsibility for scheduling on-site and off-site audits with flexibility to travel to a provider’s location when needed. This is a challenging and rewarding role for a RN with solid interpersonal and communication skills who likes independent, flexible, autonomous work. Should be detail-oriented and have a solid clinical background to conduct on-site and off-site hospital bill audits. 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. 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.

Requirements

Associate’s degree (or higher) in Nursing
Active and unrestricted RN license in the state of residence
2+ years of RN experience in an acute hospital setting
Intermediate level of proficiency with Microsoft Office applications, including Word, Excel, and Outlook
Reside within an hour away from the closest airport
Willing or ability to travel to hospital locations for audits via car and plane (overnight travel included)

Nice To Haves

Bachelor’s degree in nursing (BSN)
2+ years of Medical Claims Review experience
1+ years of previous medical record review experience
1+ years of experience working in Auditing
CPT & ICD-10 familiarity
Demonstrated ability to read and interpret medical business correspondence, procedure manuals, and specific plan documents
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

Monitoring new case assignments
Review medical records to verify services 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
25% travel via car and plan (may include overnight travel)