Clinical Appeals Auditor - LPN

Optum; Lafayette (LA); On-site; USD 59,832 - 89,748; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

401(k) contribution

Job summary

Optum is looking for a detail-oriented professional to review clinical documentation for various health services in Lafayette, Louisiana. This position requires an Associate's degree in Nursing and an unrestricted LPN licensure, along with experience in home health care.

The salary range is $59,832 to $89,748 annually, with a comprehensive benefits package that enhances your professional growth and rewards your contributions.

Qualifications

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

Responsibilities

• Review clinical documentation for Home Health and Hospice in audits.
• Coordinate and track appeal assignments and manage deadlines.
• Collaborate across departments to communicate audit trends.

Skills

Clinical documentation review

Reimbursement knowledge

Microsoft Office proficiency

Education

Associate's degree in Nursing

Bachelor's degree in Nursing

Job description

Explore opportunities with Home Office, a part of LHC Group, a leading post‑acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.

Primary Responsibilities

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

You will be rewarded and recognized for your performance in an environment that challenges you and provides clear direction on what it takes to succeed in your role. Opportunities for development are also available if you are interested in other roles.

Required Qualifications

• Associate's degree in Nursing.
• Current and unrestricted licensure as an LPN.
• 1+ years of experience in hospice, LTACH, and/or home health care.
• Working knowledge of reimbursement and compliance regulations.
• Proficient in Microsoft Office applications (Word, Excel, etc.).

Preferred Qualifications

• Bachelor's degree in Nursing.
• Experience in auditing and analyzing clinical documentation.
• Demonstrated leadership qualities.

Pay is based on several factors including local labor markets, education, work experience, certifications, and more. The salary for this role will range from $59,832 to $89,748 annually for full‑time employment. In addition to salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and a 401(k) contribution (all benefits are subject to eligibility requirements). We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We are committed to eliminating health disparities and improving health outcomes, especially for people of color and historically marginalized groups.

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

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