Coding Appeals Rn - Milwaukee, United States - UnitedHealthcare

UnitedHealthcare

Verified Company

Milwaukee, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start
Caring. Connecting. Growing together.**An experienced RN with solid interpersonal skills.

The Clinical Appeals & Coding RN would be responsible for reviewing appeals and grievances to determine if the appropriate care was given.

In providing Medicaid Community and State provider post service appeals. Our goal is to create higher quality care, lower costs and greater access to health care.

This is a telecommute, Monday - Friday from 8:30am - 5:00pm position.

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

Primary Responsibilities:

Clinical Appeals and Grievances (analyzing, reviewing appeals / grievances)
Review of coding edits and reimbursement issues
Works with less structured, more complex issues
Solves moderately complex problems and / or conducts moderately complex analyses
Translates concepts into practice
Assesses and interprets customer needs and requirements
Identifies solutions to nonstandard requests and problems
Works with mínimal guidance; seeks guidance on only the most complex tasks
Works with less structured, more complex issues
Coaches, provides feedback and guides others

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:

Active, unrestricted RN licensure in state of residence
3+ years clinical experience in a hospital, acute care or direct care setting
Experience in reviewing coding edits and reimbursement issues
Medical record review / appeal review experience
Experience working in a managed care environment (insurance company or medical group)
Proficient level of experience with Microsoft Office Suite (Word, Excel & Outlook)
Proven ability to adapt to change and work in a high volume environment
Proven outstanding coding skills with handson experience with coding edits and reimbursement issues
Proven solid critical thinking, analytical and research skills
Ability to work Monday
Friday from 8:30am 5:00pm within your time zone

Preferred Qualifications:

CPC (Certified Professional Coder)
Utilization Review experience
Clinical Chart Reviews
Post Service Provider Denial experience
Knowledge of Medicare / Medicaid regulations
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, _location_ and incomedeserves 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_._
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_._