Top 23 Clinical reviewer Jobs in Minneapolis Mn

IBR Clinical Appeals Analyst - Remote
Optum —Plymouth, MN
- $35 - $63 an hour
- Overtime
- Remote
- Microsoft Word
- Nursing
- RN License
Diagnostic Radiology- Medical Record Reviewer
Dane Street, LLC —Minneapolis, MN
- Remote
- BC/BE
- Senior level
- Radiology
Quick Apply
IBR Clinical Review RN
Optum —Plymouth, MN
- $29 - $52 an hour
- Full-time
- Remote
- Nursing
- RN License
- Pass drug screening
- AD&D insurance
- Employee stock purchase plan
Regulatory Affairs Specialist I
Boston Scientific —Maple Grove, MN
- $59,900 - $113,800 a year
- Hybrid work
- Office
- Master's degree
- Bachelor's degree
9h
Compliance Coordinator
EOSIS —New Brighton, MN
- $75,000 - $85,600 a year
- 8 hour shift
- Hybrid work
- Microsoft Outlook
- Writing skills
- Research
- Health savings account
- Paid holidays
Quick Apply
Nurse Liaison
Fairview Health Services —Minneapolis, MN
- $86,507.20 - $124,945.60 a year
- Nursing
- RN License
- Computer literacy
National Medical Director, Clinical AI Innovation and Performance - Remote
UnitedHealthcare —Minnetonka, MN
- $386,500 - $579,500 a year
- Full-time
- Remote
- Medicine
- BC/BE
- Pass drug screening
2d
Supervisor, Clinical Quality Review
Medica Services Company LLC —Minnetonka, MN
- $78,700 - $134,900 a year
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Health insurance
Principal Regulatory Affairs Specialist
Elucent Medical, Inc. —Eden Prairie, MN
- $120,000 - $135,000 a year
- Full-time
- Hybrid work
- 5 years
- Travel
- Mentoring
- Paid holidays
- Disability insurance
Quick Apply
Senior System Design Quality Engineer
Boston Scientific —Maple Grove, MN
- $85,000 - $161,500 a year
- 5 years
- Engineering
- Office
- Relocation assistance
Board-Certified Internal Medicine
Dane Street, LLC —Minneapolis, MN
- Contract
- Medicine
- Internal Medicine
- Analysis skills
Quick Apply
Board-Certified Family Practice Provider
Dane Street, LLC —Minneapolis, MN
- Contract
- Mid-level
- Analysis skills
- Communication skills
Quick Apply
Board-Certified Pain Medicine
Dane Street, LLC —Minneapolis, MN
- Contract
- BC/BE
- Mid-level
- Analysis skills
Quick Apply
Board-Certified Foot and Ankle Surgeon
Dane Street, LLC —Lake Elmo, MN
- Contract
- Surgery
- Analysis skills
- Senior level
Quick Apply
Physician ED Claims Reviewer
Vytwo —United States
- Full-time
- Remote
- Mid-level
- 2 years
Quick Apply
Provisioning & Video Review Manager
Confidential —United States
- $80,000 - $90,000 a year
- Full-time
- Google Workspace
- 5 years
- Analysis skills
- Health savings account
- Health insurance
Quick Apply
22h
Epic Tapestry UM Analyst
Vytwo —United States
- $50 an hour
- Full-time
- Remote
- 5 years
- HIPAA
- Mid-level
Quick Apply
Surgical Program Manager Adult NSQIP
Registry Partners —United States
- Weekends as needed
- Remote
- Nursing
- Surgery
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
7d

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IBR Clinical Appeals Analyst - Remote

Optum -
Plymouth, MN

Apply Now

Job Details

Full-time
$35 - $63 an hour

Qualifications

Appeals
Confidential information handling
National Correct Coding Initiative (NCCI) guidelines
RN License
Regulatory compliance
Health policy
Medical insurance appeals management
Insurance claims auditing
Insurance claims appeal handling

Full Job Description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Itemized Bill Review (IBR) Clinical Appeals Reviewer will analyze and respond to client and/or hospital claim review appeal inquiries. Handles medical record review, analyzes data, and completes the response resolution for clients and the business unit. Must utilize expertise in auditing to review and provide response to appeals. We are seeking self-motivated, solution-oriented and skilled problem solver who provides clinical reviews with written documentation under tight deadlines.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Analyze scope and resolution of IBR 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 analysts, 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:

Undergraduate nursing degree
Unrestricted RN (registered nurse) license
2+ years of appeals experience (coding or auditing)
Experience with CPT-4 coding, NCCI edit resolution and appropriate modifier use
Advanced experience with regulations, compliance and composing professional appeal responses
Advanced experience with ICD10 CM coding and ICD 10 PCS coding
Willing or ability to work our normal business hours of 8:00am - 5:00pm
Proven ability to keep all company sensitive documents secure (if applicable)
Have a dedicated work area established that is separated from other living areas and provides information privacy
Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

Clinical claim review experience
Managed care experience
Investigation and/or auditing experience
Advanced experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry
Knowledge of health insurance business, industry terminology, and regulatory guidelines

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 $35 - $63 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.

Apply Now

Refine Your Search

clinical reviewer jobs in minneapolis mn

IBR Clinical Appeals Analyst - Remote

Diagnostic Radiology- Medical Record Reviewer

IBR Clinical Review RN

Regulatory Affairs Specialist I

Compliance Coordinator

Nurse Liaison

National Medical Director, Clinical AI Innovation and Performance - Remote

Supervisor, Clinical Quality Review

Principal Regulatory Affairs Specialist

Senior System Design Quality Engineer

Board-Certified Internal Medicine

Board-Certified Family Practice Provider

Board-Certified Pain Medicine

Board-Certified Foot and Ankle Surgeon

Physician ED Claims Reviewer

Provisioning & Video Review Manager

Epic Tapestry UM Analyst

Surgical Program Manager Adult NSQIP

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