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. OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Clinical Claims Review RN
Location
United States
Posted
15 days ago
Salary
Not specified
No structured requirement data.
Job Description
Role Description
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.
- 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
- 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 plane (may include overnight travel)
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)
Requirements
- Bachelor’s degree in nursing (BSN) (Preferred)
- 2+ years of Medical Claims Review experience (Preferred)
- 1+ years of previous medical record review experience (Preferred)
- 1+ years of experience working in Auditing (Preferred)
- CPT & ICD-10 familiarity (Preferred)
- Demonstrated ability to read and interpret medical business correspondence, procedure manuals, and specific plan documents (Preferred)
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
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.
Job 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)
- Bachelor’s degree in nursing (BSN) (Preferred)
- 2+ years of Medical Claims Review experience (Preferred)
- 1+ years of previous medical record review experience (Preferred)
- 1+ years of experience working in Auditing (Preferred)
- CPT & ICD-10 familiarity (Preferred)
- Demonstrated ability to read and interpret medical business correspondence, procedure manuals, and specific plan documents (Preferred)
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
- 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.
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