IBR Clinical Review RN

About This Role

The Clinical Review RN serves as a subject matter expert for itemized bill reviews and analyzing hospital facility bills. This role is ideal for those with a comprehensive understanding of the claim review process and a background in clinical settings.

• Location: Plymouth, MN
• Schedule: Full Time, Day shift
• Pay: $29 - $52 per hour

• Conduct Forensic Reviews using independent clinical knowledge to analyze billed charges.
• Complete analysis of billing and departmental guidelines.
• Participate in the achievement and completion of department goals.
• Complete focused review of medical records to evaluate clinical course of care.
• Assist with resolution of claims to support negotiations and appeals process.
• Interact with internal business partners as requested.
• Maintain appropriate documentation on all claims according to guidelines.
• Perform research to support audit adjustments and resolve issues.
• Review and respond to research inquiries from team members.

Education:

• Associate's degree required.

Experience:

• 2+ years of clinical experience within an acute care setting required.
• 1+ years of experience working with bill review required.

Licenses &

Certifications:

• Active and unrestricted RN license OR LPN in the state of residence required.

• Paid Time Off which accrues from the first pay period plus 8 Paid Holidays.
• Medical Plan options with Health Spending Account or Health Saving Account.
• Dental, Vision, Life & AD&D Insurance, Short-term and Long-Term Disability coverage.
• 401(k) Savings Plan and Employee Stock Purchase Plan.
• Education Reimbursement.
• Employee Discounts and Employee Assistance Program.
• Employee Referral Bonus Program.
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).

United Health Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to live healthier lives.