Clinical Appeals Auditor, LPN - PRN

LeadingAge Virginia; Baton Rouge, Northern (LA, KY); Hybrid; USD 56,592,000 - 84,816,000; Full time

Job summary

UnitedHealth Group is seeking a Governmental Audit Reviewer to ensure clinical documentation stands up to scrutiny across home health, hospice, LTACHs, and community-based services.

You will lead audits, draft responses, and manage appeals while staying current with federal and state regulations to protect reimbursement and maintain compliance.

Qualifications

• Current and unrestricted licensure as a 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.

Responsibilities

• Reviews clinical documentation for Home Health, Hospice, LTACHs, and Community-Based Services in response to governmental audits.
• Ensures consistency in clinical reviews through standardized processes.
• Drafts professional response letters and manages internal determinations for audit appeals.
• Coordinates and tracks appeal assignments, meeting deadlines for hearings.
• Maintains knowledge of federal/state regulations related to compliance and reimbursement.
• Collaborates across departments to minimize disruptions and communicate audit trends.
• Supports repayment processes and additional compliance audits.

Skills

LPN License

Home health

Reimbursement knowledge

MS Office

Tools

Microsoft Office

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.

As a Governmental Audit Reviewer, you are the expert who ensures clinical documentation stands up to scrutiny. You take the lead in auditing, submitting, and appealing records for home health, hospice, LTACHs, and community-based services. When external payers come calling-whether it's ADRs, CERTs, RACs, ZPICs, or other audits-you're ready. You dive into the details, respond with precision, and defend the integrity of care through every pre- and post-payment review. Your work protects reimbursement, supports compliance, and keeps the organization audit-ready at all times.

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’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Current and unrestricted licensure as a 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

• Experience in auditing and analyzing clinical documentation
• Demonstrated leadership qualities

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $19.75 to $29.60 per hour based on full-time employment. 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 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.