Clinical Appeals & Compliance Auditor

Optum; United States; Remote; USD 28,000 - 41,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase

401k contribution

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 auditing, submitting, and appealing records for government payers (ADRs, RACs, CERTs, ZPICs). Requires an active LPN license and 1+ year in hospice or home health, with proficiency in Excel and reimbursement regulations. A comprehensive benefits package is provided.

Qualifications

• Current and unrestricted LPN licensure.
• 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).

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

Skills

LPN licensure

Hospice / Home health experience

Reimbursement knowledge

Microsoft Office

Tools

Excel

Word

Job description

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 auditing, submitting, and appealing records for government payers (ADRs, RACs, CERTs, ZPICs). Requires an active LPN license and 1+ year in hospice or home health, with proficiency in Excel and reimbursement regulations. A comprehensive benefits package is provided.