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Facility Clinical Investigator RN - US Telecommute

UnitedHealth Group Minneapolis Full-Time
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Energize your career with one of Healthcare’s fastest growing companies.  

You dream of a great career with a great company – where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

 

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

 

Primary Responsibilities:

  • Investigate, review, and provide clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
  • Perform clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
  • Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
  • Identify aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommend providers to be flagged for review
  • Maintain and manages daily case review assignments, with a high emphasis on quality
  • Provide clinical support and expertise to the other investigative and analytical areas
  • Will be working in a high volume production environment that is matrix drive

Required Qualifications:

  • High School Diploma / GED (or higher)
  • Unrestricted RN (registered nurse)
  • 1+ years of medical coding experience
  • Inpatient facility DRG experience (coding or auditing)
  • Experience with ICD-10 coding
  • Experience with ICD-10-PCS
  • Ability to work Monday through Friday, 8:00 am to 5:00 pm Central Time

Preferred Qualifications:

  • RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner) OR current certified facility in - patient coder
  • Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry
  • Healthcare claims experience
  • Managed care experience
  • Investigation and / or auditing experience
  • Knowledge of health insurance business, industry terminology, and regulatory guidelines

Soft Skills:

  • Ability to use a Windows PC with the ability to utilize multiple applications at the same time

Physical Requirements and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
  • Have a secluded office area in which to perform job duties during the work day
  • Have high - speed internet access

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM


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.


Keywords: DRG, coding, medical coding, RN, registered nurse, nurse, ICD-10, PCS, procedural coding, investigation, facility, in-patient, audit, DRG coding, DRG auditing, validation, coder, precertification, medical necessity, telecommute

 

Skills required

Electronic Medical Record
Disease Management
Hospitalization
Psychology
Long Term Care
Registered Nurse
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UnitedHealth Group is Fortune 5 and working to create the health
care system of tomorrow.  We can’t do it alone.  We need your help,
skills and drive to serve others.  
Consider your future: workatuhg.com

Our industry is focused on innovation and change. You can expect
to work a little harder, because we aim a little higher to meet the rapidly
evolving needs of healthcare.  We expect more from ourselves as well as
those who share our passion for excellence. If you’re open to that challenge,
you’ve come to the right place. Yes, we’ll test your skills, then help you to
build more. 

Through our family of businesses and a lot of inspired
individuals, we're building a high-performance health care system that works
better for more people in more ways than ever.

If you would describe yourself as compassionate, decisive, and
built for speed, we want to hear from you.  This is the place to share
your ideas and your passion for making a difference right now. We won’t promise
you the world, but we will promise you the opportunity to do
your life’s
best workSM


Because we recruit talent for a diverse range of areas - from
finance and nursing to customer service, marketing, legal and beyond – chances
are, we’ll have an opportunity for you.

UnitedHealth Group Values:

Just like you, we’re driven by values that are guiding our way
forward:

Integrity
– Honor commitments. Never compromise ethics. 
Compassion – Walk in the shoes of people we serve, and those with whom
we work.
Relationships – Build trust through collaboration.
Innovation – Invent the future, learn from the past.
Performance – Demonstrate excellence, in everything we do.

With these values as our foundation, and through the talents,
drive and compassion of people like you, UnitedHealth Group will transform
health care. And we’ll continue our evolution as a company, making an even
greater positive impact on the lives of those we serve. 

Consider your future:
workatuhg.com

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