Payment Integrity Clinical Review Specialist - Remote - UnitedHealth Group : Job Details

Collaborate with the Payment Integrity (PI) team on healthcare fraud, waste, and abuse investigations Conduct provider claim and clinical audits, preparing clinical review summaries with recommendations and proper citations and resources Review medical records and claims on a pre and post pay basis for PI cases involving fraud, waste, or abuse Support investigation and clinical discussions with federal law enforcement Apply industry, state, and federal regulations and guidelines Assess findings to detect patterns of fraud, waste, and abuse Make accurate claim decisions based on VA policies, payment rules, coding guidelines, and clinical judgment Youll 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: Active, unrestricted RN license in state of residence Certified Professional Coder...Clinical, Payment, Specialist, Integrity, Clinic, Remote, Healthcare