[Hiring] Appeals and Audit Research RN @UnitedHealth Group

Role Description

Optum Insight is improving the flow of health data and information to create a more connected system. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

• Provide coordination of the Recovery Audit Contractor (RAC) audit program, ensuring compliance with regulatory requirements and organizational standards
• Collaborate with Health Information Management (HIM), Coding, Revenue Cycle, Case Management, Physicians, and Financial Services departments
• Review, respond to, track, and monitor Medicare audits and payment reviews through final resolution
• Manage audit planning, scheduling, reporting, content management, and adherence to established audit standards and procedures
• Analyze RAC and payer audit findings to identify trends, risks, and opportunities for revenue cycle improvement
• Create and implement process improvement initiatives using trend analysis and predictive modeling to reduce audit exposure and financial risk
• Coordinate RAC requests, appeals, documentation submissions, and response timelines to ensure compliance with payer deadlines
• Track audit inventories and maintain accurate records of audit activities, outcomes, recoveries, and appeals
• Update regulatory checklists for audit reviews (internal use only)
• Develop and deliver internal education and training programs related to audit readiness, documentation, coding, and compliance standards
• Communicate audit findings, trends, and recommendations to executive leadership, including the Chief Financial Officer (CFO) and departmental stakeholders
• Apply knowledge of medical coding, billing regulations, appeals processes, and Medicare requirements to support successful audit outcomes

Qualifications

• RN license in your state of residence, or BSN status
• 3+ years of experience performing healthcare audits, appeals and discussions within a hospital or healthcare environment
• 3+ years of experience in medical coding, billing practices, reimbursement methodologies, and Medicare processes
• 3+ years of experience with appeals
• Intermediate proficiency in Microsoft Office

Requirements

• Strong communication skills
• Strong analytical, project management, reporting, and communication skills
• Ability to identify trends, manage multiple deadlines, and lead cross-functional initiatives

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Salary range from $60,200 to $107,400 annually based on full-time employment

Company Description

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.

• Committed to mitigating our impact on the environment
• Enabling and delivering equitable care that addresses health disparities and improves health outcomes
• Equal Employment Opportunity employer
• Drug-free workplace