Clinical Claim Review LPN - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

Function 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.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

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 system

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
• Current unrestricted LPN licensure in applicable state
• Proficient with computer, knowledgeable with Microsoft Office (Outlook, Excel, Word)
• Proven good written and verbal communication skills
• Proven to work with minimal guidance
• Proven ability to multi-task, manage change in a production environment

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)
• Proven solid attention to detail and maintaining quality focus (Soft Skill) and Multi-tasking
• Proven ability to learn quickly, and cross-train in multiple platforms

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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 $20.00 - $36.00 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.

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.