Description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

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 Medicaid Community and State provider post service appeals. 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.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

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

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Active unrestricted RN license in state of TN
• 3+ years clinical experience in a hospital, acute care or direct care setting
• Experience in reviewing coding edits (CPT) and reimbursement issues
• Medical record review / appeal review experience
• Experience working in a managed care environment (insurance company or medical group)
• Proficient level of experience with Microsoft Office Suite (Word, Excel & Outlook)
• Proven ability to adapt to change & work in a high volume environment
• Proven outstanding coding skills with hands-on experience with coding edits &reimbursement issues
• Proven solid critical thinking, analytical and research skills
• Ability to work Monday - Friday from 8:30am - 5:00pm within your time zone
  
  Preferred Qualifications:
• CPC (Certified Professional Coder)
• Utilization Review experience
• Clinical Chart Reviews
• Post Service Provider Denial experience
• Knowledge of Medicare / Medicaid regulations

*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 $28.94 to $51.63 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.