[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. This position involves:

• Handling medical record review
• Analyzing data and completing response resolutions for clients and the business unit
• Utilizing expertise in auditing to review and provide responses to appeals
• Working full-time, Monday - Friday, with normal business hours of 8:00am - 5:00pm
• Possibly working occasional overtime or weekends as needed
• Enjoying the flexibility to work remotely from anywhere within the U.S.

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 teams to review medical records pertaining to impacted claims
• Navigate through web-based portals and utilize online tools and resources including but not limited to Word, Adobe, and 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 able to work 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

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Hourly pay for this role will range from $35 - $63 per hour based on full-time employment

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.