Remote RN: Clinical Claims Review & Compliance

UnitedHealth Group; Massachusetts; Remoto; USD 40.000 - 72.000; Tempo pieno

Vantaggi offerti da questo lavoro

Paid time off + holidays

Medical/Dental/Vision insurance

401(k) Savings Plan

Descrizione del lavoro

The IRR Clinical Claim Review Nurse at UnitedHealth Group performs claim reviews to verify coding and charges, researching guidelines to determine claim viability. This role suits professionals with clinical experience and a solid understanding of the claim review process.

Based in Plymouth, MA with a full-time day shift, the position supports remote work anywhere in the U.S. while complying with HIPAA, state and federal regulations.

Competenze

• Associate's degree required.
• 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.
• Active and unrestricted RN license in the state of residence required.
• Auditing and coding certifications preferred or ability to obtain within 1 year of employment.

Mansioni

• Perform clinical review of professional or facility claims vs. medical records.
• Maintain standards for productivity and accuracy defined by the department.
• Complete analysis of billing and departmental guidelines.
• Provide clear and concise clinical logic to clients and providers.
• Participate in the achievement and completion of department goals.
• Complete focused review of medical records to evaluate clinical course of care.
• Assist with resolution of claims to support negotiations and appeals process.
• Ensure adherence to state and federal compliance policies.
• Maintain appropriate documentation on all claims according to departmental guidelines.
• Understand and maintain HIPAA confidentiality and privacy standards.

Conoscenze

Clinical review

Documentation accuracy

HIPAA compliance

Formazione

Associate's degree

RN license in state of residence

Auditing and coding certifications (CPC, CIC, CIC, CPB, CPMA)

Descrizione del lavoro

The IRR Clinical Claim Review Nurse at UnitedHealth Group performs claim reviews to verify coding and charges, researching guidelines to determine claim viability. This role suits professionals with clinical experience and a solid understanding of the claim review process.

Based in Plymouth, MA with a full-time day shift, the position supports remote work anywhere in the U.S. while complying with HIPAA, state and federal regulations.