IBR Clinical Appeals Analyst - Remote

UnitedHealth Group; Minnesota; Remote; USD 48,000 - 87,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group seeks an IBR Clinical Appeals Analyst to analyze and respond to claim review appeals. This fully remote role requires expertise in auditing, coding, and clinical reviews. A minimum of 2 years of appeals experience and an unrestricted RN license are mandatory.

The ideal candidate will perform complex analyses, collaborate with teams, and navigate web portals. The position offers a comprehensive benefits package including a 401k contribution and stock options.

Qualifications

• Must have 2+ years of appeals experience in coding or auditing.
• Requires unrestricted RN license.
• Advanced experience with CPT-4 and ICD coding required.

Responsibilities

• Analyze scope and resolution of IBR Appeals.
• Respond to Level one, two or higher appeals.
• Research and prepare written appeals.

Skills

Auditing

Clinical reviews

CPT-4 coding

ICD10 CM coding

ICD 10 PCS coding

Complex analysis

Education

Undergraduate nursing degree

Tools

Web-based portals

Job description

About This Role

The IBR Clinical Appeals Analyst will analyze and respond to client and hospital claim review appeal inquiries. This role is ideal for self-motivated, solution-oriented individuals with expertise in auditing and clinical reviews.

Highlights

• Location: Plymouth, MN
• Schedule: Full-time, Day shift
• Residency: Must reside in the U.S.
• Work Style: Fully remote
• Pay: $35 - $63 per hour

What You'll Do

• Analyze scope and resolution of IBR Appeals
• Respond to Level one, two or higher appeals
• Perform complex conceptual analyses
• Identify risk factors, comorbidities, and adverse events
• Review governmental regulations and payer protocols
• Research and prepare written appeals
• Exercise clinical and/or coding judgment and experience
• Collaborate with analysts, quality, and leadership teams
• Navigate web-based portals and utilize online tools
• Serve as a key resource on complex issues

Education

• Undergraduate nursing degree required

Experience

• 2+ years of appeals experience (coding or auditing) required
• Experience with CPT-4 coding and NCCI edit resolution required
• Advanced experience with ICD10 CM coding and ICD 10 PCS coding required

Licenses & Certifications

• Unrestricted RN (Registered Nurse) license required

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They strive to help people live healthier lives and make the health system work better for everyone.