Clinical Documentation Audit & Appeals Specialist

UnitedHealth Group; Baton Rouge (LA); On-site; USD 28,000 - 40,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group's Home Office is seeking a Governmental Audit Reviewer to lead audits for home health, hospice, and related services, ensuring documentation stands up to scrutiny.

You will draft response letters, manage appeals, and track deadlines for Administrative Law Judge hearings, while staying current with federal/state regulations.

The role offers competitive compensation with hourly pay and comprehensive benefits.

Qualifications

• Current and unrestricted LPN licensure
• 1+ years of hospice/home health experience preferred
• 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)
• Drafts professional response letters and manages internal determinations for audit appeals
• Coordinates and tracks appeal assignments, ensuring deadlines are met 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

Education

LPN licensure

Job description

UnitedHealth Group's Home Office is seeking a Governmental Audit Reviewer to lead audits for home health, hospice, and related services, ensuring documentation stands up to scrutiny.

You will draft response letters, manage appeals, and track deadlines for Administrative Law Judge hearings, while staying current with federal/state regulations.

The role offers competitive compensation with hourly pay and comprehensive benefits.