Clinical Documentation Audit & Appeals Specialist

Texas Health Institute; Baton Rouge, Northern (LA, KY); Hybrid; USD 27,000 - 41,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking a Governmental Audit Reviewer to lead audits of clinical documentation for home health, hospice, LTACHs, and community-based services. You will respond to government payers, draft letters, and manage appeal processes to protect reimbursement and ensure audit readiness.

The role requires LPN licensure, 1+ years in relevant care settings, and strong knowledge of reimbursement rules.

Qualifications

• Current and unrestricted licensure as a Licensed Practical Nurse (LPN).
• 1+ years of experience in hospice, LTACH, and/or home health care.
• Working knowledge of reimbursement regulations and compliance requirements.
• Proficient in Microsoft Office applications (Word, Excel, etc.).

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

MS Office

Auditing

Clinical Documentation

Leadership

Tools

Microsoft Office

Job description

UnitedHealth Group is seeking a Governmental Audit Reviewer to lead audits of clinical documentation for home health, hospice, LTACHs, and community-based services. You will respond to government payers, draft letters, and manage appeal processes to protect reimbursement and ensure audit readiness.

The role requires LPN licensure, 1+ years in relevant care settings, and strong knowledge of reimbursement rules.