Clinical Appeals RN- Coding - Remote in US - 2275489

UnitedHealth Group; Dallas (TX); Remote; Confidential; Full time

Job summary

Join a forward-thinking organization dedicated to transforming health care. As a Clinical Appeals & Coding RN, you will play a crucial role in reviewing appeals and grievances, ensuring quality care for Medicaid Community and State providers. This position offers the flexibility of remote work while tackling complex challenges in a supportive environment. Your expertise in coding and clinical experience will help shape a more equitable health care system. If you're ready to make a difference and grow your career, this opportunity is perfect for you.

Benefits

Comprehensive Benefits Package

Incentive and Recognition Programs

401k Contribution

Equity Stock Purchase

Qualifications

• Active RN licensure required with 3+ years clinical experience.
• Outstanding coding skills and experience with reimbursement issues.

Responsibilities

• Review appeals and grievances to determine appropriate care.
• Analyze coding edits and reimbursement issues.
• Coach and guide others in complex problem-solving.

Skills

Interpersonal Skills

Critical Thinking

Analytical Skills

Coding Skills

Microsoft Office Suite

Adaptability

Education

Active RN Licensure

3+ Years of Clinical Experience

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 would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. In providing Medicaid Community and State provider post service appeals. Our goal is to create higher quality care, lower costs and greater access to health care.

This is a telecommute, Monday - Friday from 8:30am - 5:00pm position.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Clinical Appeals and Grievances (analyzing, reviewing appeals / grievances)
• Review of coding edits and reimbursement issues
• Works with less structured, more complex issues
• Solves moderately complex problems and / or conducts moderately complex analyses
• Translates concepts into practice
• Assesses and interprets customer needs and requirements
• Identifies solutions to non-standard requests and problems
• Works with minimal guidance; seeks guidance on only the most complex tasks
• Works with less structured, more complex issues
• Coaches, provides feedback and guides others

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:

• Active, unrestricted RN licensure in state of residence
• Outstanding coding skills with hands-on experience with coding edits and reimbursement issues
• 3+ years of clinical experience in a hospital, acute care or direct care setting
• Experience in reviewing coding edits and reimbursement issues
• Medical record review / appeal review experience
• Proficient level of experience with Microsoft Office Suite (Word, Excel & Outlook)
• Experience working in a managed care environment (insurance company or medical group)
• Proven solid critical thinking, analytical and research skills
• Proven 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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.