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UnitedHealth Group

UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of

Clinical Claims Review RN

Location

United States

Posted

106 days ago

Salary

0

No structured requirement data.

Job Description

Clinical Claims Review RN

UnitedHealth Group

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. 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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