Clinical Appeals Auditor: Government Audits Expert

The Georgia Society of CPAs; Baton Rouge (LA); On-site; USD 28,000 - 41,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

401k contribution

Job summary

UnitedHealth Group in Baton Rouge seeks a Governmental Audit Reviewer to oversee audits of home health, hospice, LTACHs, and community-based services. You will audit, respond, appeal, and defend documentation to protect reimbursement and ensure compliance.

You will draft letters, coordinate appeals, monitor deadlines, and stay current with federal/state regulations while collaborating across departments to minimize disruptions.

Qualifications

• Current and unrestricted LPN licensure.
• 1+ years in hospice, LTACH, or home health care.
• Working knowledge of reimbursement and compliance regulations.

Responsibilities

• Reviews clinical documentation for Home Health, Hospice, LTACHs, and Community-Based Services in response to governmental audits (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 ALJ hearings.
• Maintains knowledge of federal/state regulations, industry standards, and internal policies related to compliance and reimbursement.
• Collaborates across departments to minimize disruptions and communicate audit trends for corrective action.
• Supports the Governmental Audit Supervisor with repayment processes and additional compliance audits.

Education

LPN licensure

Tools

Microsoft Excel

Microsoft Word

Job description

UnitedHealth Group in Baton Rouge seeks a Governmental Audit Reviewer to oversee audits of home health, hospice, LTACHs, and community-based services. You will audit, respond, appeal, and defend documentation to protect reimbursement and ensure compliance.

You will draft letters, coordinate appeals, monitor deadlines, and stay current with federal/state regulations while collaborating across departments to minimize disruptions.