Hospital Bill Audit Claims Selection RN - Remote

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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Hospital Bill Audit Screener RN primary responsibility is to utilize clinical knowledge to claim data to select a percent of charge claims with the highest savings potential for audit. The role analyzes client reimbursement policies and CMS guidelines to identify the best claims for audit and reject claims with low potential.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Analyze data on percent of charge hospital claims utilizing client reimbursement policies to determine if claims are appropriate for hospital bill audit.
• Act as a SME for the HBA team for claims selection or rejection.
• Utilize Optum systems and internal workflow to identify and accurately select the most appropriate claims for audit, reject claims with no audit potential, and move claims through workflow processes correctly within payer client SLAs.
• Utilize nursing knowledge to apply interpretation of client reimbursement policies to claim selections for audit.
• Work collaboratively with the claims selection team to identify and document trends in high-value claims selected and claims with no potential.
• Effectively communicate with leadership and claims selection team members regarding trends in providers and case selection.
• Maintain and manage daily claim selection assignments independently, maintaining standards for productivity and accuracy.
• Review and handle emails involving communication with other internal staff in a professional and timely manner.
• Ability to work in a high-volume production environment.
• Perform other similar and related duties as required or directed.

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

• Registered Nurse (RN) with a current, unrestricted RN License in the U.S.
• 2+ years of clinical experience in an acute care hospital specifically in O.R., specialty/critical care, or utilization management.

Preferred Qualifications

• HBA auditing experience.
• Medical coding credentials.
• Proven ability to read and interpret medical business correspondence, procedure manuals, and specific plan documents.
• Proven solid interpersonal skills to build and maintain positive working relationships with colleagues, stakeholders, and healthcare providers by facilitating open and constructive communication.
• Proven ability to actively participate in team meetings and contribute to group discussions, sharing knowledge and expertise to promote collective growth.
• Proven ability to prioritize tasks and manage time effectively.
• Proficiency in Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry.

Value Based Competencies
Integrity Value: Act Ethically

• Comply with applicable laws, regulations, and policies.
• Demonstrate integrity.

Compassion Value: Focus on Customers

• Identify and exceed customer expectations.
• Improve the customer experience.

Relationship Value: Act as a team player

• Collaborate with others.
• Demonstrate diversity awareness.
• Learn and develop.

Relationship Value: Communicate Effectively

• Influence others.
• Listen actively.
• Speak and write clearly.

Innovation Value: Support Change and Innovation

• Contribute innovative ideas.
• Work effectively in a changing environment.

Performance Value: Make Fact-Based Decisions

• Apply business knowledge.
• Use sound judgment.

Performance Value: Deliver Quality Results

• Drive for results.
• Manage time effectively.
• Produce high-quality work.

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually 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 the volume of applicants.

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. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.