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Clinical Claims Review LPN - Remote

Company: UnitedHealth Group
Location: Minnetonka
Posted on: April 28, 2021

Job Description:

Careers with Optum. We built an entire organization around one giant objective; make the health system work better for everyone. 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 an elite team. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)The M&R Readmissions LPN handles triaging (First Pass) claims-- on inpatient acute care hospital admissions occurring less than 31 days following a prior discharge.-- As part of the Readmission review process, reviews are done for: same day readmission for a related condition, same day readmission for an unrelated condition, planned readmission/leave of absence and unplanned readmissions less than 31 days after the prior discharge. These reviews are facility based,-- post service and are completed applying CMS guidelines and UHC M&R Policy guidelines. This is not a Medical Necessity review. The LPN is responsible for setting up the claim in CPA, creating a Database in our Readmission Database and in certain instances noting clinical received for review. The Clinical Claims Review LPN is responsible for retrospective medical claim review of inpatient hospital claims, following Medicare/Medicaid guidelines. Positions in this function includes those responsible for initial triage of facility claims.Primary Responsibilities

  • Sets up/documents/templates/triages medical records for Medical Claims Review
  • Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.
  • Interpreting medical records and billed codes
  • Processes correspondence letters as needed
  • Preparing reconsideration reviews for the Medical Director
  • Communication via online routing systemThere's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)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
    • Current unrestricted LPN licensure in applicable state
    • Proficient with computer, knowledgeable with Microsoft Office (Outlook, Excel, Word)Preferred Qualifications:
      • Medical coding experience
      • Claim's experience
      • Knowledge of the various platforms (Cosmos, Facets, NICE, Macess, ORS)
      • Knowledge of various applications (ECAA, PEGA, Doc360, iDRS, ORS, PCOMM)UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. --You can learn more about all we are doing to fight COVID-19 and support impacted communities: click here.----*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.--Colorado Residents Only: The hourly range for Colorado residents is $17.12 to $30.34. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentivesDiversity 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.Keywords: #RPO

Keywords: UnitedHealth Group, Minnetonka , Clinical Claims Review LPN - Remote, Healthcare , Minnetonka, Minnesota

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