Remote IRF CMG & PAI Validation Lead

UnitedHealth Group; Plymouth (MN); Híbrido; USD 120.000 - 180.000; Jornada completa

Descripción de la vacante

UnitedHealth Group is seeking an IRF CMG Coding & Payment Integrity SME to lead validation of CMG assignments, functional scoring, and comorbidity tiering for CMS IRF PPS. You will collaborate across clinical, coding, and analytics teams to recover payment variances by addressing documentation gaps and scoring discrepancies.

The role requires licensure in clinical fields and coding credentials; remote work is supported nationwide with in-office requirements in certain hubs.

Formación

• 5+ years of IRF coding or auditing experience.
• Expertise in CMG assignment and IRF PAI scoring.
• Experience applying CMS guidance in audits or compliance.

Responsabilidades

• Lead clinical validation for etiologic diagnosis and comorbidity tiering.
• Review IRF cases for CMG and tiering accuracy and coding integrity.
• Identify overpayments/underpayments tied to scoring and tiering.
• Develop audit strategies focusing on high-weight CMGs.
• Provide client-facing audit rationales and reports.

Conocimientos

IRF PPS knowledge

CMG assignment methodology

IRF PAI understanding

Data analysis

Auditing

Communication skills

Educación

Clinical Licensure in RN/PT/OT/SLP

RHIA/RHIT/CCS/CPC

Herramientas

IRF Grouper tools

CMS Web Pricer

Descripción del empleo

UnitedHealth Group is seeking an IRF CMG Coding & Payment Integrity SME to lead validation of CMG assignments, functional scoring, and comorbidity tiering for CMS IRF PPS. You will collaborate across clinical, coding, and analytics teams to recover payment variances by addressing documentation gaps and scoring discrepancies.

The role requires licensure in clinical fields and coding credentials; remote work is supported nationwide with in-office requirements in certain hubs.