University of Minnesota School of Nursing
IBR Clinical Appeals Reviewer - Remote
University of Minnesota School of Nursing, Minneapolis, Minnesota, United States, 55400
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.
Itemized Bill Review (IBR) Clinical Appeals Reviewer
will analyze and respond to client and/or hospital claim review appeal inquiries. Handles medical record review, analyzes data, and completes the response resolution for clients and the business unit. Must utilize expertise in auditing to review and provide response to appeals. We are seeking self‑motivated, solution‑oriented and skilled problem solver who provides clinical reviews with written documentation under tight deadlines.
This position is full‑time, Monday ‑ Friday. Employees are required to work our normal business hours of 8:00am ‑ 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Analyze scope and resolution of IBR Appeals
Respond to Level one, two or higher appeals
Perform complex conceptual analyses
Identifies risk factors, comorbidities', and adverse events, to determine if overpayment or claim adjustment is needed
Reviews governmental regulations and payer protocols and / or medical policy to recommend appropriate actions
Researches and prepares written appeals
Exercises clinical and/or coding judgment and experience
Collaborates with existing auditors, quality and leadership team to seek to understand, and review medical records pertaining to impacted claims
Navigates through web‑based portals and independently utilizes other online tools and resources including but not limited to word, adobe, excel
Serve as a key resource on complex and / or critical issues and help develop innovative solutions
Define and document / communicate business requirements
Required Qualifications:
Undergraduate nursing degree
Unrestricted RN (registered nurse) license
2+ years of appeals experience (coding or auditing)
Experience with CPT-4 coding, NCCI edit resolution and appropriate modifier use
Advanced experience with regulations, compliance and composing professional appeal responses
Advanced experience with ICD10 CM coding and ICD 10 PCS coding
Willing or ability to work our normal business hours of 8:00am ‑ 5:00pm
Proven ability to keep all company sensitive documents secure (if applicable)
Have a dedicated work area established that is separated from other living areas and provides information privacy
Live in a location that can receive a UnitedHealth Group approved high‑speed internet connection or leverage an existing high‑speed internet service
Preferred Qualifications:
Clinical claim review experience
Managed care experience
Investigation and/or auditing experience
Advanced experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry
Knowledge of health insurance business, industry terminology, and regulatory guidelines
*All employees working remotely 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 hourly pay for this role will range from $35.00 to $62.50 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.
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.
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Caring. Connecting. Growing together.
Itemized Bill Review (IBR) Clinical Appeals Reviewer
will analyze and respond to client and/or hospital claim review appeal inquiries. Handles medical record review, analyzes data, and completes the response resolution for clients and the business unit. Must utilize expertise in auditing to review and provide response to appeals. We are seeking self‑motivated, solution‑oriented and skilled problem solver who provides clinical reviews with written documentation under tight deadlines.
This position is full‑time, Monday ‑ Friday. Employees are required to work our normal business hours of 8:00am ‑ 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Analyze scope and resolution of IBR Appeals
Respond to Level one, two or higher appeals
Perform complex conceptual analyses
Identifies risk factors, comorbidities', and adverse events, to determine if overpayment or claim adjustment is needed
Reviews governmental regulations and payer protocols and / or medical policy to recommend appropriate actions
Researches and prepares written appeals
Exercises clinical and/or coding judgment and experience
Collaborates with existing auditors, quality and leadership team to seek to understand, and review medical records pertaining to impacted claims
Navigates through web‑based portals and independently utilizes other online tools and resources including but not limited to word, adobe, excel
Serve as a key resource on complex and / or critical issues and help develop innovative solutions
Define and document / communicate business requirements
Required Qualifications:
Undergraduate nursing degree
Unrestricted RN (registered nurse) license
2+ years of appeals experience (coding or auditing)
Experience with CPT-4 coding, NCCI edit resolution and appropriate modifier use
Advanced experience with regulations, compliance and composing professional appeal responses
Advanced experience with ICD10 CM coding and ICD 10 PCS coding
Willing or ability to work our normal business hours of 8:00am ‑ 5:00pm
Proven ability to keep all company sensitive documents secure (if applicable)
Have a dedicated work area established that is separated from other living areas and provides information privacy
Live in a location that can receive a UnitedHealth Group approved high‑speed internet connection or leverage an existing high‑speed internet service
Preferred Qualifications:
Clinical claim review experience
Managed care experience
Investigation and/or auditing experience
Advanced experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry
Knowledge of health insurance business, industry terminology, and regulatory guidelines
*All employees working remotely 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 hourly pay for this role will range from $35.00 to $62.50 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.
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.
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