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Facility Clinical Investigator RN - US Telecommute

Optum Eden Prairie, MN
  • Posted: 16 days ago
  • Full-Time
  • Benefits: Vision, Medical, Life Insurance, 401k, Dental

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

833057000

Optum

Why Work Here?

Optum® is a health services and innovation company.

Optum, the fast growing part of UnitedHealth Group, is a leading information and technology-enabled health services business. Our teams are dedicated to modernizing the health care system and improving the lives of people and communities. Serving virtually every dimension of the health system, we work with a diverse set of clients across 150 countries – from those who diagnose and treat patients to those who pay for care, deliver health services, and those who supply the cures. Optum maintains operations across North America, South America, Europe, Asia Pacific and the Middle East. Our innovative partnerships provide technology and tools that enable unprecedented collaboration and efficiency. As a result, we can tap into valuable health care data to uncover insights and develop strategies for better care at lower costs. We want to make health care work better for everyone. This depends on hiring the best and brightest. Explore opportunities today and begin your life’s best workSM.

Address

US Telecommute
Eden Prairie, MN
USA

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