Appeals and Audit Research RN

Job description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: • Provide coordination of the Recovery Audit Contractor (RAC) audit program, ensuring compliance with regulatory requirements and organizational standards • Collaborate with Health Information Management (HIM), Coding, Revenue Cycle, Case Management, Physicians, and Financial Services departments • Review, respond to, track, and monitor Medicare audits and payment reviews through final resolution • Manage audit planning, scheduling, reporting, content management, and adherence to established audit standards and procedures • Analyze RAC and payer audit findings to identify trends, risks, and opportunities for revenue cycle improvement • Create and implement process improvement initiatives using trend analysis and predictive modeling to reduce audit exposure and financial risk • Coordinate RAC requests, appeals, documentation submissions, and response timelines to ensure compliance with payer deadlines • Track audit inventories and maintain accurate records of audit activities, outcomes, recoveries, and appeals • Updating regulatory checklists for audit reviews (internal use only) • Develop and deliver internal education and training programs related to audit readiness, documentation, coding, and compliance standards • Communicate audit findings, trends, and recommendations to executive leadership, including the Chief Financial Officer (CFO) and departmental stakeholders • Apply knowledge of medical coding, billing regulations, appeals processes, and Medicare requirements to support successful audit outcomes You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Responsibilities

Requirements

• • RN license in your state of residence, or BSN status • 3+ years of experience performing healthcare audits, appeals and discussions within a hospital or healthcare environment • 3+ years of experience in medical coding, billing practices, reimbursement methodologies, and Medicare processes • 3+ years of experience with appeals • Intermediate proficiency in Microsoft Office Soft Skills: • Strong communication skills • Strong analytical, project management, reporting, and communication skills • Ability to identify trends, manage multiple deadlines, and lead cross-functional initiatives *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN

About UnitedHealth Group / Optum

Optum Home & Community Care is part of UnitedHealth Group and provides telephonic case management services to help members navigate the health care system and access support services. As an RN Case Manager, you would assess members' health status, identify gaps in treatment plans, establish care goals, coordinate with multidisciplinary teams including mental health clinicians, provide patient education and coaching, make referrals to community resources, and facilitate transitions between care settings—primarily through phone calls in a high-volume customer service environment.