Payment Integrity Claim Review RN - Remote in US - UnitedHealth Group : Job Details

Perform clinical coverage review for medical services, which require interpretation of applicable benefit language, and consideration of relevant clinical information Function as a member of a self-directed team to meet specific individual and team performance metrics Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing medical reviews Ability to communicate in writing and verbally, all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations, and reimbursement determinations Analyze, identify trends, and provide reports as necessary Detect, analyze, and investigate complex types of fraud, waste, abuse, and error activity Prepare recommendations on how to remediate gaps and improve processes and resources, including establishing procedures and improving coding edits Work independently Act as a resource for others Youll be rewarded and recognized for your performance i...RN, Payment, Integrity, Remote, Health, Healthcare