Clinical Documentation Audit & Appeals Specialist

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

Job summary

UnitedHealth Group in Louisiana seeks a Governmental Audit Reviewer to lead audits of home health, hospice, LTACHs and community-based services. You review clinical documentation, draft responses, and manage appeals to protect reimbursement and ensure compliance.

You’ll collaborate across departments, stay current with federal and state regulations, and support audit readiness. A current LPN license and 1+ year in related care settings are required.

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.

Responsibilities

• Reviews clinical documentation for home health, hospice, LTACHs, and community-based services in response to governmental audits.
• 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.
• 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

LPN licensure

Audit experience

Microsoft Office

Tools

Microsoft Word

Microsoft Excel

Job description

UnitedHealth Group in Louisiana seeks a Governmental Audit Reviewer to lead audits of home health, hospice, LTACHs and community-based services. You review clinical documentation, draft responses, and manage appeals to protect reimbursement and ensure compliance.

You’ll collaborate across departments, stay current with federal and state regulations, and support audit readiness. A current LPN license and 1+ year in related care settings are required.