Clinical Appeals Auditor - LPN

Primary 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
• Captures 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

Required Qualifications

• 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.)

Preferred Qualifications

• Bachelor's degree in Nursing
• Experience in auditing and analyzing clinical documentation
• Demonstrated leadership qualities

Pay and Benefits

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).

The salary for this role will range from $59,832 to $89,748 annually based on full-time employment.

We comply with all minimum wage laws as applicable.

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.