RN Clinical Signoff Reviewer - National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Confirm findings on completed clinical validation reviews to verify the accuracy of DRG assignment and reimbursement as it pertains to clinical criteria with a focus on overpayment identification Perform, and provide oversight for clinical coding review to ensure accuracy of medical coding by utilizing clinical expertise and judgment to determine correct coding and billing Utilize solid command of anatomy and physiology as it pertains to ICD-10-CM code assignment Write/edit clear, accurate and concise rationales in support of clinical findings in conjunction with ICD-10-CM Official Coding Guidelines, and AHA Coding Clinics Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements Maintain and manage daily case review assignments, with a high emphasis on quality Provide clinical support and expertise to the other investigative and analytical areas Work in a high-volume production environment that is matrix driven