Clinical Appeals RN- Coding - Remote in US

Lensa; Dallas (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Clinical Appeals RN to join their remote team. This role focuses on reviewing appeals and grievances to enhance healthcare quality while reducing costs. With a flexible work schedule, you will tackle meaningful challenges from anywhere in the U.S. Your expertise in coding, critical thinking, and problem-solving will be essential in navigating complex issues and providing guidance to others. Join a mission-driven organization committed to improving health outcomes and making a difference in communities across the nation.

Benefits

Comprehensive Benefits Package

Incentive Programs

Stock Purchase Options

401k Contributions

Qualifications

• 3+ years of clinical experience in hospital or acute care settings.
• Outstanding coding skills with hands-on experience in reimbursement issues.

Responsibilities

• Analyze and review clinical appeals and grievances.
• Handle complex issues and solve moderately complex problems.

Skills

Coding Skills

Critical Thinking

Analytical Skills

Interpersonal Skills

Problem Solving

Education

Active RN Licensure

CPC Certification

Tools

Microsoft Office Suite

Job description

Clinical Appeals RN- Coding - Remote in US

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

An experienced RN with strong interpersonal skills is needed. The Clinical Appeals & Coding RN will review appeals and grievances to determine if appropriate care was provided, focusing on Medicaid Community and State provider post-service appeals. Our goal is to improve care quality, reduce costs, and increase access to healthcare.

This is a telecommute position, Monday - Friday, 8:30 am - 5:00 pm, allowing you the flexibility to work remotely from anywhere within the U.S., tackling meaningful challenges.

Primary Responsibilities

• Analyze and review clinical appeals and grievances
• Review coding edits and reimbursement issues
• Handle less structured, more complex issues
• Solve moderately complex problems and conduct analyses
• Translate concepts into practice
• Assess and interpret customer needs and requirements
• Identify solutions for non-standard requests and problems
• Work independently with minimal guidance; seek guidance on complex tasks
• Coach, provide feedback, and guide others

Required Qualifications

• Active, unrestricted RN licensure in the state of residence
• Outstanding coding skills with hands-on experience with coding edits and reimbursement issues
• At least 3 years of clinical experience in hospital, acute care, or direct care settings
• Experience reviewing coding edits and reimbursement issues
• Medical record review and appeal review experience
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook)
• Experience working in a managed care environment (insurance or medical group)
• Strong critical thinking, analytical, and research skills
• Ability to adapt to change and work in a high-volume environment

Preferred Qualifications

• CPC (Certified Professional Coder)
• Utilization Review experience
• Post-Service Provider Denial experience
• Knowledge of Medicare/Medicaid regulations
• Clinical Chart Reviews

Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

Compensation and Benefits

The hourly range is $28.61 to $56.06, based on full-time employment and various factors such as location, education, experience, and certifications. Benefits include comprehensive packages, incentive and recognition programs, stock purchase options, and 401k contributions, subject to eligibility.

Application Details

This posting remains open for at least 2 business days or until enough candidates apply. Early removal is possible due to high volume.

At UnitedHealth Group, our mission is to help people live healthier lives and improve the health system for all. We are committed to equity, sustainability, and addressing health disparities, with a focus on inclusive care and environmental responsibility.

UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates must pass a drug test prior to employment.