RN Governmental Audit Reviewer

UnitedHealth Group•Lafayette, LA

9h•$59,832 - $89,748

About The Position

Explore opportunities with Home Office, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As a Governmental Audit Reviewer, you are the expert who ensures clinical documentation stands up to scrutiny. You take the lead in auditing, submitting, and appealing records for home health, hospice, LTACHs, and community-based services. When external payers come calling—whether it's ADRs, CERTs, RACs, ZPICs, or other audits—you’re ready. You dive into the details, respond with precision, and defend the integrity of care through every pre- and post-payment review. Your work protects reimbursement, supports compliance, and keeps the organization audit-ready at all times.

Requirements

Associate’s degree in Nursing
Current and unrestricted licensure as a LPN
1+ years of experience in hospice, LTACH, and/or home health care
Working knowledge of reimbursement and compliance regulations
Proficient in Microsoft Office applications (Word, Excel, etc.)

Nice To Haves

Bachelor’s degree in Nursing
Experience in auditing and analyzing clinical documentation
Demonstrated leadership qualities

Responsibilities

Reviews clinical documentation for Home Health, Hospice, LTACHs, and Community-Based Services in response to governmental audits (e.g., ADRs, RACs, CERTs, ZPICs)
Ensures consistency in clinical reviews through standardized processes and high inter-rater reliability
Drafts professional response letters and manages internal determinations for audit appeals
Coordinates and tracks appeal assignments, ensuring deadlines are met and documentation is prepared for Administrative Law Judge hearings
Maintains up-to-date knowledge of federal/state regulations, industry standards, and internal policies related to compliance and reimbursement
Collaborates across departments to minimize operational disruptions and communicate audit trends for corrective action
Supports the Governmental Audit Supervisor with repayment processes and additional compliance audits