[Hiring] IBR Clinical Appeals Analyst @UnitedHealth Group

Role Description

The Itemized Bill Review (IBR) Clinical Appeals Reviewer will analyze and respond to client and/or hospital claim review appeal inquiries. Handles medical record review, analyzes data, and completes the response resolution for clients and the business unit. Must utilize expertise in auditing to review and provide response to appeals. We are seeking self-motivated, solution-oriented and skilled problem solvers who provide clinical reviews with written documentation under tight deadlines.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Analyze scope and resolution of IBR Appeals
• Respond to Level one, two or higher appeals
• Perform complex conceptual analyses
• Identify risk factors, comorbidities, and adverse events to determine if overpayment or claim adjustment is needed
• Review governmental regulations and payer protocols and/or medical policy to recommend appropriate actions
• Research and prepare written appeals
• Exercise clinical and/or coding judgment and experience
• Collaborate with existing analysts, quality and leadership team to seek to understand and review medical records pertaining to impacted claims
• Navigate through web-based portals and independently utilize other online tools and resources including but not limited to Word, Adobe, Excel
• Serve as a key resource on complex and/or critical issues and help develop innovative solutions
• Define and document/communicate business requirements

Qualifications

• Undergraduate nursing degree
• Unrestricted RN (registered nurse) license
• 2+ years of appeals experience (coding or auditing)
• Experience with CPT-4 coding, NCCI edit resolution and appropriate modifier use
• Advanced experience with regulations, compliance and composing professional appeal responses
• Advanced experience with ICD10 CM coding and ICD 10 PCS coding
• Willing or ability to work our normal business hours of 8:00am - 5:00pm
• Proven ability to keep all company sensitive documents secure (if applicable)
• Have a dedicated work area established that is separated from other living areas and provides information privacy
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications

• Clinical claim review experience
• Managed care experience
• Investigation and/or auditing experience
• Advanced experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry
• Knowledge of health insurance business, industry terminology, and regulatory guidelines

Requirements

• *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Benefits

• 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).
• The hourly pay for this role will range from $35 - $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.