Remote IBR Clinical Appeals Analyst (RN)

Optum; Plymouth (MN); Remote; USD 48,000 - 87,000; Full time

Job summary

Optum Insight is hiring for an Itemized Bill Review (IBR) Clinical Appeals Reviewer to analyze hospital claim appeals, review medical records, and prepare written responses under tight deadlines. The role supports remote work from anywhere in the U.S. with standard business hours and possible overtime.

Primary duties include handling Level 1–higher appeals and ensuring compliance with CPT/NCCI guidelines. The ideal candidate holds an undergraduate nursing degree, an active RN license, and 2+

Qualifications

• RN license and undergraduate nursing degree required.
• 2+ years of appeals experience (coding or auditing).
• Experience with CPT-4 coding, NCCI edit resolution and modifiers.
• ICD-10 CM/ICD-10 PCS coding experience required.
• Strong regulatory/compliance and professional appeal writing.
• Proficiency with Microsoft Excel and other Office tools.

Responsibilities

• Analyze scope and resolution of IBR Appeals.
• Respond to Level 1, 2 or higher appeals.
• Perform complex conceptual analyses and identify risk factors.
• Review regulations and payer policies to recommend actions.
• Research and prepare written appeals with clinical judgment.
• Collaborate with analysts, quality and leadership teams.

Skills

RN license

Appeals experience

CPT-4 coding

ICD-10 coding

Regulatory knowledge

Microsoft Excel

Education

Undergraduate nursing degree

Tools

Microsoft Word

Adobe

Microsoft Excel

Job description

Optum Insight is hiring for an Itemized Bill Review (IBR) Clinical Appeals Reviewer to analyze hospital claim appeals, review medical records, and prepare written responses under tight deadlines. The role supports remote work from anywhere in the U.S. with standard business hours and possible overtime.

Primary duties include handling Level 1–higher appeals and ensuring compliance with CPT/NCCI guidelines. The ideal candidate holds an undergraduate nursing degree, an active RN license, and 2+