Senior HBA Clinical Claims Review RN

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.

Joining us to start Caring. Connecting. Growing together.

As a Clinical Claims Review RN
, you will conduct hospital bill audits by reviewing the medical record against the itemized bill to verify services were provided and documented. A hospital bill audit identifies overcharges, undercharges, unbundled items and applies client specific policies to their reviews. There will be a responsibility for scheduling on-site and off-site audits with flexibility to travel to a provider's location when needed.

This is a challenging and rewarding role for a RN with strong interpersonal and communication skills who likes independent, flexible, autonomous work. Should be detail-oriented and have a strong clinical background to conduct on-site and off-site hospital bill audits.

Schedule: Monday – Friday, 8:00 – 5:00pm and 25% travel to hospital locations for audit reviews within the region. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

• Monitoring new case assignments
• Review medical records to verify services provided and charges are accurate – Identify overcharges, undercharges, and apply client specific policies
• Scheduling on-site and off-site reviews – work that is assigned, contact providers and schedule dates and times to perform onsite, travel onsite as needed and perform reviews
• Comply with HIPAA and other regulations regarding the confidentiality of patient information
• Ensuring charges are generated in the most cost-effective manner for the client
• Mentoring other nurses and being used as a SME resource
• Working on special projects as assigned
• 25% overnight travel to provider offices

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

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• Associate’s Degree (or higher) in Nursing
• Active and unrestricted RN license in the state of residence
• 2+ years of RN experience in an acute hospital setting
• Intermediate level of proficiency with Microsoft Office applications, including Word, Excel, and Outlook
• Reside within an hour away from the closest airport
• Ability to travel to hospital locations for audits (Overnight travel included)

• Bachelor’s Degree in Nursing (BSN)
• 2+ years of Medical Claims Review experience
• 1+ years of previous medical record review experience
• 1+ years of experience working in Auditing
• Ability to read and interpret medical business correspondence, procedure manuals, and specific plan documents.
• CPT & ICD-10 familiarity

* All Telecommuters will be required to adhere to United Health Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education,…