Remote RN: Clinical Claim Review & Coding Specialist

Optum; United States; Remote; USD 3.995.000 - 7.164.000; Vollzeit

Benefits dieser Stelle

Paid Time Off

Medical plan options

Dental & Vision

Life & AD&D

401(k)

Education reimbursement

Employee discounts

Employee assistance program

Referral bonus

Voluntary benefits

Zusammenfassung

Optum is seeking a remote IRR Clinical Claim Review Nurse to perform clinical review of claims against medical records and guidelines. The role requires an active RN license, 2+ years of acute care clinical experience, and 1+ year in claim review or related areas.

You will adhere to HIPAA and internal policies while supporting efficient billings and coding integrity. You will work from home anywhere in the United States, enjoying a competitive benefits package and professional development

Qualifikationen

• Associate's degree required.
• Active and unrestricted RN license in the state of residence.
• 2+ years of clinical experience in an acute care setting.
• 1+ years in Utilization Management, pre-authorization, claim review, appeals review, or medical record review.
• Intermediate level of computer skills including proficiency in Microsoft Office, Word, Excel, Outlook, and SharePoint.

Aufgaben

• Perform clinical review of professional or facility claims vs. medical records to determine if the claim is supported or unsupported.
• Maintain standards for productivity and accuracy as defined by the department.
• Complete analysis of billing and departmental guidelines.
• Provide clear and concise clinical logic to clients and providers when necessary.
• Participate as needed in the achievement and completion of department goals.
• Complete focused review of medical records to evaluate clinical course of care as applicable.
• Assist with resolution of claims to support negotiations and appeals process.
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance.
• Maintain appropriate documentation on all claims according to departmental guidelines and procedures.

Kenntnisse

RN license

Clinical experience

Microsoft Office

Ausbildung

Associate's degree

Tools

Microsoft Office

SharePoint

Jobbeschreibung

Optum is seeking a remote IRR Clinical Claim Review Nurse to perform clinical review of claims against medical records and guidelines. The role requires an active RN license, 2+ years of acute care clinical experience, and 1+ year in claim review or related areas.

You will adhere to HIPAA and internal policies while supporting efficient billings and coding integrity. You will work from home anywhere in the United States, enjoying a competitive benefits package and professional development