Clinical Claims Review RN - National Remote

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.

Schedule: Monday - Friday, 8:00-5:00pm and may include 25%25 travel to hospital locations by car and plane for audit reviews within the region

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.

Primary 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%25 travel via car and plan (may include overnight travel)

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. 

Required Qualifications:

• 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)

Preferred Qualifications:

• 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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.  

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.