We are currently seeking an experienced RN with strong interpersonal skills to join our team. The chosen Clinical Appeals & Coding RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given. In providing consumer-oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us, and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. This is a telecommute, Monday-Friday from 8:30am - 5:00 pm position. Primary Responsibilities: Clinical Appeals and Grievances (analyzing, reviewing appeals / grievances) Review of coding edits and reimbursement issues Works with less structured, more complex issues Solves moderately complex problems and / or conducts moderately complex analyses Translates concepts into practice Assesses and interprets customer needs and requirements Identifies solutions to non-standard requests and problems Works with minimal guidance; seeks guidance on only the most complex tasks Works with less structured, more complex issues Coaches, provides feedback and guides others .
Required Qualifications: Active, unrestricted RN licensure in your state of residence Outstanding coding skills with hands-on experience with coding edits and reimbursement issues 3+ years clinical experience in a hospital, acute care or direct care setting Experience in reviewing coding edits and reimbursement issues Medical record review / appeal review experience Proficient level of experience with Microsoft Office Suite (Word, Excel & Outlook) Strong critical thinking, analytical and research skills Ability to adapt to change and work in a high volume environment Experience working in a managed care environment (insurance company or medical group) Preferred Qualifications:CPC (Certified Professional Coder) Previous Utilization Review experience Knowledge of Medicare / Medicaid regulations Knowledge of Milliman guidelines Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) 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: telecommute, work from home, work at home, clinical, appeals, coding, RN
Our mission is to help people live healthier lives and to help make the health system work better for everyone.
- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities.
- We work with health care professionals and other key partners to expand access to quality health care so people get the care t...hey need at an affordable price.
- We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.