Clinical Appeals RN- Coding - Remote in US

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

Job summary

Join a forward-thinking organization dedicated to transforming the healthcare landscape. This telecommute role offers you the flexibility to work from anywhere in the U.S. as a Clinical Appeals & Coding RN. You will play a critical role in reviewing appeals and grievances, ensuring quality care for Medicaid patients. With a focus on collaboration and innovation, you will have the opportunity to tackle complex challenges while contributing to a mission that prioritizes health equity and community well-being. If you have a passion for making a difference in healthcare, this position is perfect for you.

Benefits

Comprehensive benefits package

Incentives and recognition programs

Stock purchase options

401k contributions

Qualifications

• 3+ years of clinical experience in a hospital or direct care setting.
• Outstanding coding skills with experience in reimbursement issues.

Responsibilities

• Analyze and review clinical appeals and grievances.
• Handle complex issues and provide guidance to others.

Skills

Coding Skills

Critical Thinking

Analytical Skills

Interpersonal Skills

Research Skills

Adaptability

Education

Active RN Licensure

CPC Certification

Tools

Microsoft Office Suite

Job description

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. The Clinical Appeals & Coding RN will be responsible for reviewing appeals and grievances to determine if appropriate care was provided, specifically in Medicaid Community and State provider post-service appeals. Our goal is to create higher quality care, lower costs, and greater access to healthcare.

This is a telecommute position, Monday - Friday from 8:30 am - 5:00 pm. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

1. Analyze and review clinical appeals and grievances.
2. Review coding edits and reimbursement issues.
3. Handle less structured, more complex issues.
4. Solve moderately complex problems and conduct analyses.
5. Translate concepts into practice.
6. Assess and interpret customer needs and requirements.
7. Identify solutions to non-standard requests and problems.
8. Work with minimal guidance; seek guidance only on the most complex tasks.
9. Coach, provide feedback, and guide others.

We offer a challenging environment with clear success pathways and development opportunities for other roles you may be interested in.

Required Qualifications

1. Active, unrestricted RN licensure in your state of residence.
2. Outstanding coding skills with hands-on experience with coding edits and reimbursement issues.
3. 3+ years of clinical experience in a hospital, acute care, or direct care setting.
4. Experience in reviewing coding edits and reimbursement issues.
5. Medical record review and appeal review experience.
6. Proficiency with Microsoft Office Suite (Word, Excel, Outlook).
7. Experience working in a managed care environment.
8. Strong critical thinking, analytical, and research skills.
9. Ability to adapt to change and work in a high-volume environment.

Preferred Qualifications

1. CPC (Certified Professional Coder).
2. Utilization Review experience.
3. Post-Service Provider Denial experience.
4. Knowledge of Medicare/Medicaid regulations.
5. Clinical Chart Reviews.
6. Adherence to UnitedHealth Group’s Telecommuter Policy for remote employees.

The hourly rate ranges from $28.61 to $56.06, based on full-time employment, with pay determined by factors including local labor markets, education, experience, and certifications. Benefits include a comprehensive package, incentives, recognition programs, stock purchase options, and 401k contributions, subject to eligibility.

The application will be posted for at least 2 business days or until a sufficient candidate pool is reached. Early removal may occur due to volume of applications.

Our mission is to help people live healthier lives and improve the health system for everyone. We are committed to equity, environmental sustainability, and addressing health disparities, especially among marginalized groups. We are an Equal Employment Opportunity employer and a drug-free workplace, requiring candidates to pass a drug test prior to employment.