
Clinical Appeals RN- Coding - Remote in US
Lensa
Full time
Software Development
United States
Hiring from: United States
Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
An experienced RN with strong interpersonal skills. The Clinical Appeals & Coding RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. In providing Medicaid Community and State provider post service appeals. Our goal is to create higher quality care, lower costs and greater access to health care.
This is a telecommute, Monday - Friday from 8:30am - 5:00pm position.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
Required Qualifications
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.
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
An experienced RN with strong interpersonal skills. The Clinical Appeals & Coding RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. In providing Medicaid Community and State provider post service appeals. Our goal is to create higher quality care, lower costs and greater access to health care.
This is a telecommute, Monday - Friday from 8:30am - 5:00pm position.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Clinical Appeals and Grievances (analyzing, reviewing appeals / grievances)
- Review of coding edits and reimbursement issues
- Works with less structured, more complex issues
- Solves moderately complex problems and / or conducts moderately complex analyses
- Translates concepts into practice
- Assesses and interprets customer needs and requirements
- Identifies solutions to non-standard requests and problems
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Works with less structured, more complex issues
- Coaches, provides feedback and guides others
Required Qualifications
- Active, unrestricted RN licensure in state of residence
- Outstanding coding skills with hands-on experience with coding edits and reimbursement issues
- 3+ years of clinical experience in a hospital, acute care or direct care setting
- Experience in reviewing coding edits and reimbursement issues
- Medical record review / appeal review experience
- Proficient level of experience with Microsoft Office Suite (Word, Excel & Outlook)
- Experience working in a managed care environment (insurance company or medical group)
- Proven solid critical thinking, analytical and research skills
- Proven ability to adapt to change and work in a high volume environment
- CPC (Certified Professional Coder)
- Utilization Review experience
- Post Service Provider Denial experience
- Knowledge of Medicare / Medicaid regulations
- Clinical Chart Reviews
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
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.
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