Remote RN: Clinical Claim Review & Coding Support

UnitedHealth Group; Plymouth (MA); Remote; USD 40,000 - 72,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan

Dental & Vision Insurance

Job summary

UnitedHealth Group seeks an IRR Clinical Claim Review Nurse to perform claim reviews, verify coding and charges, and document findings. You will research state and federal guidelines and apply internal procedures to determine claim viability in a production environment. Telecommute from anywhere in the U.S.

with limited supervision. The role requires RN licensure in your state, 2+ years of acute care experience, and 1+ year in claims review or related areas.

Qualifications

• Active and unrestricted RN license in the state of residence.
• 2+ years of clinical experience within an acute care setting.
• 1+ years of experience in Utilization Management, pre-authorization, claim review, appeals review, or medical record review.
• Proficiency with Microsoft Office, Word, Excel, Outlook, and SharePoint.

Responsibilities

• Perform clinical review of professional or facility claims vs. medical records.
• Maintain standards for productivity and accuracy.
• Complete analysis of billing and departmental guidelines.
• Provide clear clinical logic to clients and providers.
• Participate in department goals achievement.
• Review medical records to evaluate clinical course of care.
• Assist with resolution of claims to support negotiations and appeals.
• Ensure adherence to HIPAA, policies and billing guidelines.
• Document all claims per guidelines.

Skills

Proficient in Microsoft Office

RN license

HIPAA knowledge

Clinical claim review

Research and documentation

Education

Associate's degree

Tools

SharePoint

Excel

Job description

UnitedHealth Group seeks an IRR Clinical Claim Review Nurse to perform claim reviews, verify coding and charges, and document findings. You will research state and federal guidelines and apply internal procedures to determine claim viability in a production environment. Telecommute from anywhere in the U.S.

with limited supervision. The role requires RN licensure in your state, 2+ years of acute care experience, and 1+ year in claims review or related areas.