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Hospital Charge Audit Nurse Auditor, RN

4 months ago

Eden Prairie, United States Optum Full time

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.SM

The primary focus of this position is to perform remote and onsite hospital charge audits of both inpatient and outpatient hospital claims as assigned. Audits are conducted as a medical record review of all billed charges to identify over, under and late charges; as well as ensure provider reimbursement is within client guidelines and policies. These are not DRG or medical necessity audits. Audits must be completed during specific time frames as set by State, client, provider and company policy and regulations.

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

Primary Responsibilities:

  • Perform remote and onsite hospital bill charge audits as assigned while meeting department quality expectations
  • Manage case inventory to ensure timely scheduling of remote and onsite audits while maintaining weekly productivity goals
  • Ability to assess case details and provide input into audit potential of facilities & cases
  • Effectively interact and communicate with teammates & providers regarding all steps of the audit process. Some interaction with clients may occasionally be required as well
  • Utilize nursing knowledge in conjunction with interpretation of the medical record to identify discrepancies in billed charges
  • Develop recommendations and possible solutions to resolve audit disputes that have resulted in incomplete audit closure
  • Other duties as requested

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:

  • Associate Degree (or higher) in Nursing
  • Current RN license
  • 2+ years of clinical experience in an acute care hospital specifically in O.R., specialty care or utilization management
  • 2+ years of experience in use of the electronic medical record (EMR)
  • Ability to travel up to 25% , with the assumed overnight stays required per business needs
  • The ability to sit or stand for long-periods of time, on occasion for the full length of the audit. The ability to maneuver all required audit equipment, i.e. laptop, manuals, files and charts, etc. over varying distances

Preferred Qualifications:

  • BSN
  • Medical coding credentials
  • Hospital charge audit experience
  • Ability to prepare clear, concise, and legible audit forms
  • Ability to self-schedule for audits and travel
  • Operating room or critical care experience
  • Proficiency with Microsoft office including Outlook, Word and Excel

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


California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii or Washington Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island or Washington residents is $28.03 to $54.95 per hour. 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.

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.

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.

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