Optum

RN Clinical Signoff Reviewer - National Remote

Posted on

June 29, 2025

Job Type

Full-Time

Role Type

Clinical Operations

License

RN

State License

Minnesota

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Help & Resources

Company Description

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.

Job Description

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

Requirements

Required Qualifications: Associate’s degree (or higher) Active, unrestricted RN (Registered Nurse) license in the state of residence 1+ years of DRG/ICD-10 Official Coding Guidelines experience, and/or CCS/CIC certified Preferred Qualifications: CCS or CIC certification Experience with prior DRG concurrent and/or retrospective overpayment identification audits Experience with DRG encoder tools (ex. 3M) Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry Healthcare claims experience Managed care experience Knowledge of health insurance business, industry terminology, and regulatory guidelines Soft Skills: Ability to use a Windows PC with the ability to utilize multiple applications at the same time Demonstrate excellent written and verbal communication skills, solid analytical skills, and attention to detail Ability to work independently in a remote environment and deliver exceptional results Excellent time management and work prioritization skills

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Responsibilities

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

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