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Job Details

UnitedHealth Group

Sr Clinical Claim Review RN - Remote




California, Maryland, United States

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

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

Primary Responsibilities:

  • Performs DRG validation reviews
  • Performs other duties as assigned
  • Utilizes encoders and various coding resources
  • Maintains strict patient and physician confidentiality and follows all federal, state and hospital guidelines for release of information

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:

  • High School Diploma / GED (or higher)
  • Certified Inpatient Coder (CIC) or Nursing Licensure with coding experience
  • Knowledge of CMS and AMA coding rules specific to ICD-10, PCS, CPT, HCPCS
  • Knowledge of CMS Coverage, Federal and State Statues, Rules, and Regulations
  • Maintains current working knowledge of Inpatient coding conventions and standards, including ICD-10 coding principles, Coding Clinics, government regulations, and protocols
  • Comprehensive understanding of hospital coding and billing techniques and revenue cycles
  • Proficient with personal computers, including Microsoft Suite of products
  • Verifies the following elements in the medical record
    • Accuracy of the sequencing of codes
    • Accuracy of the diagnostic code assignment(s)
    • Accuracy of the procedure code assignment(s)
    • Verification of physician-ordered inpatient status
    • Accuracy of present on admission indicator assignment(s)
    • Accuracy of DRG grouping assignment and associated payment

Preferred Qualifications:

  • Certified Outpatient Coder (COC)
  • Certified Professional Coder (CPC)
  • Medicaid and/or Medicare experience
  • Presentation or policy documentation experience

Telecommuting Requirements:

  • Ability to keep all company sensitive documents secure (if applicable)
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

  • Ability to work in a team
  • Solid customer service skills
  • Solid analytical and problem-solving skills
  • Solid written and verbal communications skills

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

Colorado, Connecticut, Nevada, or New York City Residents Only: The hourly range for Colorado residents is $31.78 to $56.88. The hourly range for Connecticut/Nevada/New York City residents is $35.00 to $62.45. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.