[Remote] Clinical Appeals Auditor - Remote
Note: The job is a remote job and is open to candidates in USA. Optum, part of LHC Group, is a leading post-acute care partner dedicated to helping people feel their best. The Clinical Appeals Auditor will ensure clinical documentation meets standards by auditing and appealing records for various health services, while maintaining compliance and protecting reimbursement. This role offers the flexibility to work remotely within the U.S.
Responsibilities
- Reviews clinical documentation for Home Health, Hospice, LTACHs, and Community-Based Services in response to governmental audits (e.g., ADRs, RACs, CERTs, ZPICs)
- Ensures consistency in clinical reviews through standardized processes and high inter-rater reliability
- Drafts professional response letters and manages internal determinations for audit appeals
- Coordinates and tracks appeal assignments, ensuring deadlines are met and documentation is prepared for Administrative Law Judge hearings
- Maintains up-to-date knowledge of federal/state regulations, industry standards, and internal policies related to compliance and reimbursement
- Collaborates across departments to minimize operational disruptions and communicate audit trends for corrective action
- Supports the Governmental Audit Supervisor with repayment processes and additional compliance audits
Skills
- Associate's degree in Nursing
- Current and unrestricted licensure as a LPN
- 1+ years of experience in hospice, LTACH, and/or home health care
- Working knowledge of reimbursement and compliance regulations
- Proficient in Microsoft Office applications (Word, Excel, etc.)
- Bachelor's degree in Nursing
- Experience in auditing and analyzing clinical documentation
- Demonstrated leadership qualities
- All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Company Overview
Company H1B Sponsorship