Remote IBR Clinical Appeals Reviewer

University of Minnesota School of Nursing; Plymouth (MN); Remote; USD 100,289,000 - 180,521,000; Full time

Job summary

UnitedHealth Group seeks an experienced Clinical Appeals Reviewer for the Itemized Bill Review (IBR) team. The role analyzes appeals, reviews medical records, and drafts written responses with coding and auditing expertise. Remote work within the U.S.

is available, with standard 8:00am–5:00pm hours and potential overtime. Responsibilities include resolving Level 1–3 appeals, identifying overpayments, and ensuring compliance with CPT/NCCI and ICD-10 coding.

Qualifications

• Undergraduate nursing degree required.
• Unrestricted RN license required.
• 2+ years of appeals experience (coding or auditing).
• Experience with CPT-4 coding, NCCI edit resolution and appropriate modifier use.
• Advanced experience with regulations, compliance and composing professional appeal responses.
• Advanced experience with ICD-10-CM and ICD-10-PCS coding.
• Willingness to work 8:00am–5:00pm U.S. business hours.
• Candidates must maintain patient data privacy.

Responsibilities

• Analyze scope and resolution of IBR Appeals.
• Respond to Level 1, 2 or higher appeals.
• Perform complex conceptual analyses.
• Identify risk factors and determine if overpayment or adjustment is needed.
• Review governmental regulations, payer protocols and medical policy.
• Prepare written appeals and document clinical judgments.
• Collaborate with analysts and leadership to review medical records.
• Navigate web portals and online tools (Word, Excel, etc.).
• Serve as a resource on complex issues and develop innovative solutions.
• Define and document business requirements.

Education

Undergraduate nursing degree

Unrestricted RN license

Tools

CPT-4 coding

NCCI edit resolution

ICD-10 CM coding

ICD-10 PCS coding

Job description

UnitedHealth Group seeks an experienced Clinical Appeals Reviewer for the Itemized Bill Review (IBR) team. The role analyzes appeals, reviews medical records, and drafts written responses with coding and auditing expertise. Remote work within the U.S.

is available, with standard 8:00am–5:00pm hours and potential overtime. Responsibilities include resolving Level 1–3 appeals, identifying overpayments, and ensuring compliance with CPT/NCCI and ICD-10 coding.