Remote Nurse Auditor (Short Stay Billing Validation), MN

Optum

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Requisition Number: 2188329
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.

As a Registered Nurse Auditor (Short Stay Billing Validation), SSBV, you are responsible for performing accurate clinical audits of inpatient medical records to validate the accuracy of the inpatient billing and reimbursement utilizing evidence base criteria, InterQual and or MCG.

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

Schedule: 6:30am to 6:30pm (8-hour shift) within your local time.

Primary Responsibilities:

  • Performs SSBV Audits by applying extensive knowledge of clinical criteria and guidelines accurately and objectively while maintaining productivity targets
  • Demonstrates ability to appropriately apply clinical criteria to a variety of claims scenarios and effectively utilize audit tools to maximize savings
  • Works independently to meet or exceed productivity and accuracy goals
  • Communicates audit findings with excellent grammar and writing skills
  • Maintains current knowledge of clinical guidelines, reimbursement trends, and client expectations
  • Demonstrates commitment to Optum Insight core values. The position responsibilities outlined above are in no way to be construed as all encompassing.  Other duties, responsibilities, and qualifications may be required and/or assigned as necessary

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 Degree (or higher) in Nursing
  • Current, unrestricted RN license in the state of residency
  • 3+ years of clinical nursing experience in the inpatient setting
  • 3+ years experience in advanced clinical documentation review or audit experience  which may include healthcare compliance, post payment audit, case management, utilization review, and clinical documentation improvement
  • 1+ year previous and recent experience with the application of InterQual and or MCG evidence-based criteria
  • Intermediate proficiency with MS Office along with good ability to learn new systems
  • A designated home work space with access to install secure high-speed internet via cable/DS

Soft Skills:

  • Ability to perform in-depth analysis of clinical documentation
  • Excellent spoken and written communication skills
  • Excellent analytical skills
  • High level organizational and prioritization skills with the ability to manage multiple, concurrent projects and tasks effectively
  • Ability to be decisive and work well independently
  • Advanced experience with national evidence based screening guidelines

*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 per hour. 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. 

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.