IBR Clinical Appeals Analyst - Remote
Primary Responsibilities
- Analyze scope and resolution of IBR Appeals
- Respond to Level one, two or higher appeals
- Perform complex conceptual analyses
- Identifies risk factors, comorbidities', and adverse events, to determine if overpayment or claim adjustment is needed
- Reviews governmental regulations and payer protocols and / or medical policy to recommend appropriate actions
- Researches and prepares written appeals
- Exercises clinical and/or coding judgment and experience
- Collaborates with existing analysts, quality and leadership team to seek to understand, and review medical records pertaining to impacted claims
- Navigates through web-based portals and independently utilizes other online tools and resources including but not limited to word, adobe, excel
- Serve as a key resource on complex and / or critical issues and help develop innovative solutions
- Define and document / communicate business requirements
Required Qualifications
- Undergraduate nursing degree
- Unrestricted RN (registered nurse) license
- 2+ years of appeals experience (coding or auditing)
- Advanced experience with regulations, compliance and composing professional appeal responses
- Advanced experience with ICD10 CM coding and ICD 10 PCS coding
- Proven ability to keep all company sensitive documents secure (if applicable)
- Willing or ability to work our normal business hours of 8:00am - 5:00pm
- Have a dedicated work area established that is separated from other living areas and provides information privacy
- Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Preferred Qualifications
- Clinical claim review experience
- Managed care experience
- Investigation and/or auditing experience
- Advanced experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry
- Knowledge of health insurance business, industry terminology, and regulatory guidelines
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).
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 $35 - $63 per hour based on full-time employment.
We comply with all minimum wage laws as applicable.
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.