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DRG Appeals Lead - National Remote

Company: UnitedHealth Group
Location: Chicago
Posted on: September 25, 2022

Job Description:

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. The -DRG Appeals Lead -utilizes subject matter expertise in DRG auditing to review and provide response to appeals. By partnering with the original auditor, review medical records, and other information to author a rebuttal or agreement with the facility. This person will be instrumental in providing coaching and education to our remote team DRG Validation Specialists utilizing core coding and medical information science. -We are seeking self-motivated, solution oriented and skilled problem solver who provides written documentation in under tight deadlines. -As a -DRG Appeals Lead, you will derive key insights from the appeals and provide guidance and direction to fellow auditors across our business. - This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. -Training will be conducted virtually from your home. *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Primary Responsibilities:

  • Analyze scope and resolution of DRG Appeals -
  • Respond to Level one, two or higher appeals.
  • Perform complex conceptual analyses
  • Identifies risk factors, comorbidities', and adverse events, to determine if overpayment or claim adjustment is needed. -
  • Reviews governmental regulations and payer protocols and / or medical policy to recommend appropriate actions
  • Researches and prepares written appeals
  • Exercises clinical and/or coding judgment and experience
  • Collaborates with existing auditors, quality and leadership team to seek to understand, and review medical records pertaining to impacted claims.
  • Navigates through web-based portals and independently utilizes other online tools and resources including but not limited to word, adobe, excel
  • Serve as a key resource on complex and / or critical issues and help develop innovative solutions
  • Define and document / communicate business requirements 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:
    • High School Diploma -/ GED (or higher)
    • Unrestricted RN (registered nurse)
    • Inpatient facility DRG experience (coding or auditing)
    • Experience with ICD10 CM coding
    • Experience with ICD10 PCS coding
    • Ability to work an 8 hour shift between 8:00am - 5:00pm including the flexibility to work occasional overtime per business need Preferred Qualifications:
      • RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner) CCS (certified coding specialist) OR CIC (certified inpatient coder)
      • Experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry
      • Healthcare claims experience
      • Managed care experience
      • Investigation and/or auditing experience
      • Knowledge of health insurance business, industry terminology, and regulatory guidelines Telecommuting Requirements:
        • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
        • Ability to keep all company sensitive documents secure (if applicable)
        • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status. Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at Learn how Teresa, a Senior Quality Analyst, -works with -military veterans and ensures they receive the best benefits and experience possible. - Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life's best work.SM Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 - $118,300. The salary range for Connecticut / Nevada residents is $72,800 - $129,900. 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 incentives 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. Keywords: #RPO, #YELLOW

Keywords: UnitedHealth Group, Chicago , DRG Appeals Lead - National Remote, Other , Chicago, Illinois

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