Clinical Documentation Audit & Appeals Specialist

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

Benefits offered by this job

Comprehensive benefits

401k plan

Incentive and recognition programs

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 draft response letters, manage appeals, and coordinate deadlines with internal teams while ensuring regulatory compliance and accurate reimbursement.

The role requires LPN licensure and 1+ year experience in relevant care settings, with strong MS Office skills.

Qualifications

• Current and unrestricted LPN licensure.
• 1+ years of experience in hospice, LTACH, and/or home health care.
• Working knowledge of reimbursement and compliance regulations.
• 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

Microsoft Office

Education

LPN licensure

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 draft response letters, manage appeals, and coordinate deadlines with internal teams while ensuring regulatory compliance and accurate reimbursement.

The role requires LPN licensure and 1+ year experience in relevant care settings, with strong MS Office skills.