[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 role involves:

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

Primary Responsibilities include:

• Analyzing scope and resolution of IBR Appeals.
• Responding to Level one, two or higher appeals.
• Performing complex conceptual analyses.
• Identifying risk factors, comorbidities, and adverse events to determine if overpayment or claim adjustment is needed.
• Reviewing governmental regulations and payer protocols and/or medical policy to recommend appropriate actions.
• Researching and preparing written appeals.
• Exercising clinical and/or coding judgment and experience.
• Collaborating with existing analysts, quality, and leadership teams to review medical records pertaining to impacted claims.
• Navigating through web-based portals and utilizing online tools and resources including but not limited to Word, Adobe, and Excel.
• Serving as a key resource on complex and/or critical issues and helping develop innovative solutions.
• Defining and documenting/communicating 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.