IBR Clinical Appeals Reviewer - National Remote

Lensa; Minneapolis (MN); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading company is seeking an IBR Clinical Appeals Reviewer to analyze client claims and provide solutions. This full-time remote position requires an RN license and experience in appeals. Join us to make a meaningful impact in healthcare.

Benefits

Comprehensive benefits

Incentive programs

Stock purchase options

401k contributions

Qualifications

• 2+ years of appeals experience including coding and auditing.
• Proficiency with ICD-10-CM and ICD-10-PCS coding.

Responsibilities

• Analyze and respond to client and hospital claim review appeal inquiries.
• Collaborate with auditors and leadership teams to review medical records.

Skills

Problem Solving

Data Analysis

Auditing

Clinical Review

Education

Associates degree or higher

Tools

Excel

Word

Adobe

Job description

IBR Clinical Appeals Reviewer - National Remote

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

Optum, a part of UnitedHealth Group, is a global organization delivering care through innovative technology to help millions live healthier lives. Join us to make a meaningful impact on health outcomes and advance health equity worldwide. Our culture values diversity, inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Itemized Bill Review (IBR) Clinical Appeals Reviewer will analyze and respond to client and hospital claim review appeal inquiries. Responsibilities include medical record review, data analysis, and completing response resolutions for clients and the business unit. The role requires expertise in auditing to review and respond to appeals. We seek self-motivated, solution-oriented, and skilled problem solvers who can provide clinical reviews with proper documentation under tight deadlines.

This position is full-time, Monday to Friday, with normal business hours from 8:00 am to 5:00 pm. Occasional overtime or weekend work may be necessary based on business needs.

You’ll have the flexibility to telecommute* from anywhere within the U.S. while tackling challenging tasks.

Primary Responsibilities

• 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 to determine if overpayment or claim adjustment is needed
• Review governmental regulations, payer protocols, and medical policies to recommend appropriate actions
• Research and prepare written appeals
• Use clinical and coding judgment and experience
• Collaborate with auditors, quality, and leadership teams to review medical records related to claims
• Navigate web portals and utilize online tools such as Word, Adobe, and Excel
• Serve as a resource on complex issues and develop innovative solutions
• Define, document, and communicate business requirements

We offer a challenging environment with clear performance expectations and development opportunities for your career growth.

Required Qualifications

• Associates degree or higher
• Unrestricted RN (Registered Nurse) license
• 2+ years of appeals experience (coding or auditing), including CPT-4 coding, NCCI edit resolution, and modifier use
• Proficiency with regulations, compliance, and professional appeal responses
• Proficiency with ICD-10-CM and ICD-10-PCS coding
• Ability to work normal hours (8:00 am – 5:00 pm)

Preferred Qualifications

• Advanced Excel skills (creating/editing spreadsheets, sorting, filtering, data entry)
• Clinical claim review experience
• Managed care experience
• Investigation and auditing experience
• Knowledge of health insurance industry, terminology, and regulations

Telecommuting Requirements

• Secure handling of sensitive documents
• Dedicated, private work area
• High-speed internet connection
• Adherence to UnitedHealth Group’s Telecommuter Policy

The salary range is $34.42 to $67.60 per hour, based on full-time employment and various factors. Benefits include comprehensive packages, incentive programs, stock purchase options, and 401k contributions. We support diversity and equal opportunity employment, and we are committed to health equity and environmental sustainability.

Pursuant to the San Francisco Fair Chance Ordinance, we consider qualified applicants with arrest and conviction records.

Application Deadline: This posting remains for at least 2 business days or until a sufficient candidate pool is reached. Early removal may occur due to volume.

Our mission is to help people live healthier lives and improve healthcare for all, addressing disparities faced by marginalized groups and lower-income populations. We are an Equal Employment Opportunity employer and a drug-free workplace requiring a pre-employment drug test.