Remote Nurse Auditor, Implants and Drugs, Plymouth, MN

Optum

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Requisition Number: 2183897
Job Category: Nursing
Primary Location: Plymouth, MN
(Remote considered)

Opportunities at Change Healthcare, part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals, and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: Caring. Connecting. Growing together.  

The Nurse Auditor, Implants and Drugs will work remotely and independently but also collaborate as part of a specialized team of auditors, office support staff and management. They will be performing quality checks on all completed work for thoroughness and accuracy. The Nurse Auditor will be submitting completed work in a timely manner with attention to client, state, and contractual timeframes. The successful individual will have the ability to adapt to a changing and growing environment.

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

Schedule: Monday to Friday 8-hour shifts between the hours of 6:30am to 6:30pm within your local time for Eastern Time Zone.

Primary Responsibilities:

  • Review operative reports, medication administration records, hospital billing and manufacturer invoices to determine if the billing and payment for implants and high-cost drugs are supported by the records, and payment or anticipated payment is accurate according to the contract terms between the payor and the facility
  • Communicate decisions regarding contract and reimbursement determinations
  • Speak with health care facilities to explain audit result and obtain additional clinical information as needed.
  • This is high volume, customer service environment. You’ll need to be efficient, productive, and thorough dealing with our members over the phone. Strong computer and software navigation skills are critical. You should also be strongly patient-focused and adaptable to changes.

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: http://uhg.hr/uhgbenefits

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

  • Associate’s Degree (or higher) in Nursing
  • Current, unrestricted Registered Nurse licensure in the state in which you reside
  • 1+ years of experience in clinical documentation review or audit experience, which may include healthcare compliance, post payment audit or clinical documentation improvement
  • Intermediate level of proficiency with MS Word, (create, edit, save documents) and Outlook (email and calendar management), also able to navigate on the web through multiple applications
  • Intermediate proficiency in Excel
  • A designated workspace with access to install secure high-speed internet via cable/DSL and access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)

Preferred Qualifications

  • Operating Room nursing or Infusion experience
  • 2 + years of experience performing audits to verify accurate documentation and reimbursement
  • 1+ years of experience in conflict resolution and ability to identify, define and explain day-to-day problems and solutions
  • 2+ years of Acute care experience
  • Basic knowledge of CPT, ICD10, HCPCS, NUBC or other coding structures
  • Experience calculating drug costs and verifying accurate drug unit billing

Soft Skills:

  • Strong oral and written communication skills
  • Demonstrated effective organizational skills and scheduling skills as observed in day-to-day work
  • Excellent interpersonal and problem-solving skills
  • Attention to detail, as observed in day-to-day work
  • Excellent time management and prioritization skills
  • Must demonstrate flexibility, ability to follow through on all tasks in a timely fashion, good attention to detail and a willingness to learn
  • Strong team player, initiative in achieving individual and team goals, and team building skills
  • Demonstrates initiative in achieving individual, team, and organizational goals and objectives

*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.

 

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.