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Clinical Appeals Consultant - Telecommute

Job Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Responsible for conducting reviews and responding to insurance denials. Writes concise, factual letters and provides medical record documentation to support appeal. Effectively communicates verbally with external and internal customers to ensure argument for appeal is clearly presented. Responsible for the denials process, including subsequent appeal to health insurance
  • Assures appropriate action is taken within appeal time frames to address clinical denial
  • Collaborates with other departments/resources/entities as applicable to ensure the most optimal appeal outcome
  • On a monthly basis presents identified denial trends and patterns and creates education on root cases and preventable measures
  • Utilizes appropriate applications (MIDAS +, Veracity, Artiva, eFR, EDM) to accurately track clinical denial data; participates in the development and implementation of a system-wide process for appeals
  • Reviews and has knowledge of applicable Medicare, Medicaid, or Commercial determinations and policies, including Local Coverage Determinations, National Coverage Determinations, Policy Bulletins, etc.
  • Assists with continuous quality improvement of the established appeals process
  • Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
  • Works in conjunction with multiple units including CDI, coding, legal, Mid/Back rev cycle teams, Providers, payers, and other vendors

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:

  • Undergraduate degree or equivalent experience
  • Registered Nurse, medical school graduate, Physician Assistant (RN, NP, PA, MD, DO, MBBS) OR an RHIA/RHIT
  • 2+ years of experience preparing appeals for clinical denials or writing clinical denials on behalf of payers
  • Proven knowledge of medicine and pathophysiology with understanding of clinical criteria and treatment of medical diagnoses
  • Clinical discernment/critical thinking skill to identify what defines the patient encounter
  • Proficient in PC use, Microsoft applications (Word, Excel, PowerPoint) and working knowledge of hospital department computer systems
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • CPC, CCS or equivalent Coding Certification
  • Certification in Clinical Documentation Improvement (CCDS or CDIP)
  • 3+ years of appeals, coding, or CDI experience
  • Excellent written communication skills with the ability to clearly articulate ideas and arguments in a letter
  • Sound verbal communication and organization skills

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.


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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.


 Job Keywords:clinical appeals, consultant, telecommute, remote, work from home

Job Requirements

 

Job Snapshot

Location US-AZ-Phoenix
Employment Type Full-Time Employee
Pay Type Year
Pay Rate N/A
Store Type Other
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Company Overview

UnitedHealth Group

Careers at UnitedHealth Group. We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these select few, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. Learn More

Contact Information

US-AZ-Phoenix
Snapshot
UnitedHealth Group
Company:
US-AZ-Phoenix
Location:
Full-Time Employee
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Other
Store Type:

Job Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Responsible for conducting reviews and responding to insurance denials. Writes concise, factual letters and provides medical record documentation to support appeal. Effectively communicates verbally with external and internal customers to ensure argument for appeal is clearly presented. Responsible for the denials process, including subsequent appeal to health insurance
  • Assures appropriate action is taken within appeal time frames to address clinical denial
  • Collaborates with other departments/resources/entities as applicable to ensure the most optimal appeal outcome
  • On a monthly basis presents identified denial trends and patterns and creates education on root cases and preventable measures
  • Utilizes appropriate applications (MIDAS +, Veracity, Artiva, eFR, EDM) to accurately track clinical denial data; participates in the development and implementation of a system-wide process for appeals
  • Reviews and has knowledge of applicable Medicare, Medicaid, or Commercial determinations and policies, including Local Coverage Determinations, National Coverage Determinations, Policy Bulletins, etc.
  • Assists with continuous quality improvement of the established appeals process
  • Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
  • Works in conjunction with multiple units including CDI, coding, legal, Mid/Back rev cycle teams, Providers, payers, and other vendors

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:

  • Undergraduate degree or equivalent experience
  • Registered Nurse, medical school graduate, Physician Assistant (RN, NP, PA, MD, DO, MBBS) OR an RHIA/RHIT
  • 2+ years of experience preparing appeals for clinical denials or writing clinical denials on behalf of payers
  • Proven knowledge of medicine and pathophysiology with understanding of clinical criteria and treatment of medical diagnoses
  • Clinical discernment/critical thinking skill to identify what defines the patient encounter
  • Proficient in PC use, Microsoft applications (Word, Excel, PowerPoint) and working knowledge of hospital department computer systems
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • CPC, CCS or equivalent Coding Certification
  • Certification in Clinical Documentation Improvement (CCDS or CDIP)
  • 3+ years of appeals, coding, or CDI experience
  • Excellent written communication skills with the ability to clearly articulate ideas and arguments in a letter
  • Sound verbal communication and organization skills

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.


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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.


 Job Keywords:clinical appeals, consultant, telecommute, remote, work from home

Job Requirements

 
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