Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm)
As a Clinical Claims Review RN, you will conduct hospital bill audits by reviewing the medical record against the itemized bill to verify services were provided and documented. Hospital bill audits identify overcharges, undercharges, unbundled items and applies client specific policies to their reviews. There will be responsibility for scheduling on-site and off-site audits with flexibility to travel to a provider location when needed. This is a challenging and rewarding role for a RN with strong interpersonal and communication skills who likes independent, flexible, autonomous work. Should be detail-oriented and have strong clinical background to conduct on-site and off-site hospital bill audits.
This role will be telecommute when not traveling to onsite locations, but will be required to reside within commuting distance of the LA area.
*Travel to client sites in the Los Angeles and surrounding area will be required for on site audits*
If you are located within Los Angeles, CA area, you will have the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities:
- Monitoring new case assignments
- Review medical records to verify services were provided and charges are accurate – Identify overcharges, undercharges, and apply client specific policies
- Scheduling on-site and off-site reviews – work that is assigned, contact providers and schedule dates and times to perform onsite, travel onsite as needed and perform reviews
- On-site audits will be conducted in the Los Angeles CA area
- Comply with HIPAA and other regulations regarding the confidentiality of patient information
- Ensuring charges are generated in the most cost-effective manner for the client
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Active RN license
- 3+ years RN experience in an acute setting
- Proficient level of experience with Microsoft Office applications, including Word, Excel, and Outlook
Preferred Qualifications:
- Undergraduate degree (BSN)
- Medical record review experience
- 2+ years of Medical Claims Review experience
- Ability to read and interpret medical business correspondence, procedure manuals, and specific plan documents.
- CPT & ICD-10 familiarity
Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Claims Review, Claims RN, Claims Audit, Hospital Bill Audit, RN, Telecommute, Telecommuting, Telecommuter, Work From Home, Remote, Los Angeles, CA, California