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Skills: Clinical Claim Review, Medical Record Review, Coding Verification, Billing Guidelines, HIPAA Compliance
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$29/hr–$52/hr
Full-time
associate degree, professional certificate
Paid Time Off, Paid Holidays, Medical Plan, Health Spending Account, Health Saving Account, Dental Insurance
Posted 16d ago
~40 hrs/week
Remote in United States
Responsibilities
Perform clinical reviews of professional and facility claims against medical records to verify correct coding and charges. Ensure adherence to state and federal compliance policies while providing clinical logic to clients and providers.
Requirements
Requires an Associate's degree, an active RN license, and at least 2 years of acute care clinical experience. Candidates must also have 1+ years of experience in utilization management, claim review, or medical record review.
Full job description
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 IRR Clinical Claim Review Nurse performs claim reviews to verify correct coding and correct charges. The clinical reviewer is responsible for documenting, researching state and federal guidelines and following internal procedures to determine the viability of the claim for further review in a production environment. Employees in this position receive limited supervision within a broad framework of policies and procedures and possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable processes, procedures and billing guidelines.
You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Clinical Claim Reviews:
Perform clinical review of professional or facility claims vs. medical records to determine if the claim is supported or unsupported
Maintain standards for productivity and accuracy. Standards are defined by the department
Complete analysis of billing and departmental guidelines
Provide clear and concise clinical logic to the clients and providers when necessary
Participation as needed in the achievement and completion of department goals
Complete focused review of medical records to evaluate clinical course of care as applicable
Assists with resolution of claims as needed to support negotiations and appeals process
Ensue adherence to state and federal compliance policies, reimbursement policies, and contract compliance
Maintains appropriate documentation on all claims according to departmental guidelines and procedures
Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Associate’s degree
Active and unrestricted RN license in the state of residence
2+ years of clinical experience within an acute care setting
1+ years of experience in one of the following areas Utilization Management, pre-authorization, claim review, appeals review, or medical record review
Intermediate level of computer skills including proficiency in Microsoft Office, Word, Excel, Outlook, and SharePoint
Preferred Qualifications:
Auditing and coding certifications (CPC, COC, CIC, CPB, CPMA) or ability to obtain within 1 year of employment
CPT & HCPCS Coding experience
Experience working with medical terminology and coding
Proven ability to work independently
Experience working with plan benefit language and CMS (Medicaid and Medicare)
Strong written and verbal communication skills
Strong organizational and critical thinking skills
All Telecommuters 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 hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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.
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.
#RPO #GREEN
Related keywords
RNClinical Claim ReviewMedical CodingCPTHCPCSCPCCOCCICCPBCPMAUtilization ManagementMedicareMedicaidCMSHIPAAAcute Care
UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
We are 340,000 colleagues in two distinct and complementary businesses working to help build a modern, high-performing health system through improved access, affordability, outcomes and experiences.
Optum delivers care aided by technology and data, empowering people, partners and providers with the guidance and tools they need to achieve better health. UnitedHealthcare offers a full range of health benefits, enabling affordable coverage, simplifying the health care experience and delivering access to high-quality care.
We work with governments, employers, partners and providers to care for 147 million people and share a vision of a value-based system of care that provides compassionate and equitable care.
At UnitedHealth Group, our mission calls us, our values guide us and our diverse culture connects us as we seek to improve care for the consumers we are privileged to serve and their communities.
Click below to search careers or join our social communities:
• Search & apply for careers at careers.unitedhealthgroup.com/
• Follow us on Twitter at twitter.com/UnitedHealthGrp
• Follow and like us on Facebook at facebook.com/unitedhealthgroup
• Follow us on Instagram at instagram.com/unitedhealthgroup
More about UnitedHealth Group can be found at unitedhealthgroup.com/
Offices: Eden Prairie , Minnesota, US · 2716 N Tenaya Way, Las Vegas, NV 89128, US · 4425 E Cotton Center Blvd, Phoenix, AZ 85040, US · 1900 E Golf Rd, Schaumburg, IL 60173, US · 8822 Three Chopt Rd, Henrico, VA 23229, US
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Based on 6517 listings with disclosed salaries, most healthcare jobs in Massachusetts pay between $75k–$215k per year. Individual offers vary with seniority, company size, and specialization.
How many Healthcare jobs are open in Massachusetts right now?
There are currently 22,163 open healthcare positions in Massachusetts listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Massachusetts?
Companies currently hiring include Mass General Brigham, CVS Health, UMass Memorial Health, Anna Jaques Hospital, BOSTON MEDICAL CENTER, BOSTON, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Massachusetts?
Yes — 3793 of the 22163 open healthcare positions offer remote or hybrid work (984 remote, 2809 hybrid).
How do I apply for Healthcare jobs in Massachusetts?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.