Remote Clinical Claims Review RN, MN


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Requisition Number: 2184865
Job Category: Nursing
Primary Location: Plymouth, MN
(Remote considered)

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work.SM 

As a Clinical Claims Review RN, you will conduct hospital bill audits by reviewing the medical record against the itemized bill to verify services were provided and documented. A hospital bill audit identifies overcharges, undercharges, unbundled items and applies client specific policies to their reviews. There will be responsibility for scheduling on-site and off-site audits with flexibility to travel to a provider location when needed. This is a challenging and rewarding role for a RN with strong interpersonal and communication skills who likes independent, flexible, autonomous work. Should be detail-oriented and have strong clinical background to conduct on-site and off-site hospital bill audits.

Schedule: Monday – Friday, 8:00-5:00pm and potential travel to hospital locations for audit reviews within region

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

Primary Responsibilities:

  •  Monitoring new case assignments
  • Review medical records to verify services were provided and charges are accurate – Identify overcharges, undercharges, and apply client specific policies
  •  Scheduling on-site and off-site reviews – work that is assigned, contact providers and schedule dates and times to perform onsite, travel onsite as needed and perform reviews
  • Comply with HIPAA and other regulations regarding the confidentiality of patient information
  •  Ensuring charges are generated in the most cost-effective manner for the client

What are the reasons to consider working for UnitedHealth Group?   Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
  • More information can be downloaded at:

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:

  • Associates Degree (or higher) in Nursing
  • Active and unrestricted RN license in the state of residence
  • 3+ years of RN experience in an acute hospital setting
  • 1+ year of previous medical record review experience
  • Intermediate level of proficiency with Microsoft Office applications, including Word, Excel, and Outlook
  • Ability to travel to hospital locations within your region for audits

Preferred Qualifications:

  • Bachelor’s Degree in Nursing (BSN)
  • 2+ years of Medical Claims Review experience
  • Ability to read and interpret medical business correspondence, procedure manuals, and specific plan documents.
  • CPT & ICD-10 familiarity

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington residents is $27.07 to $53.08. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.