LPN Medical Record Auditor - Telecommute in Phoenix, AZ
Location: Phoenix, Arizona
Internal Number: 109396786
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)
This position will be based working from home and will require travel up to 50% of the time to provider offices and to the local Phoenix office for meetings as needed.
General Job Profile
This position will be responsible for the gathering and auditing of medical records from contracted medical providers
Analyze track and report results. Recommend, develop, and implement quality improvement plans with providers and follow up as necessary
If you are located within Phoenix, AZ you will have the flexibility to telecommute* as you take on some tough challenges.
Review, audit and Evaluate documentation of medical record
Review/interpret medical records/data to determine whether there is documentation reflected accurately in medical record
Follow relevant regulatory guidelines, policies and procedures in reviewing clinical documentation
Prioritize providers for medical chart review according to collaboration with other Health Plans
Identify incomplete/inconsistent information in medical records and label missing measures/metrics/concerns
Review relevant tool specifications to guide chart review
Review/interpret/summarize medical records/data to address any quality of care questions
Verify necessary documentation is included in medical records
Maintain HIPAA requirements for sharing minimum necessary information
Based on review of clinical data/documentation, identify potential quality of care issues (e.g., variations from standard practice potentially resulting in adverse outcomes) and potential fraud/waste/abuse.
Refer issues identified to relevant parties (e.g., review committee, Case Management, Medical Directors) for further review/action
Talk to provider offices to address and request corrective action plans
Educate provider representatives/office staff to address/improve auditing processes
Educate providers on proper medical record documentation for regulatory compliance
Educate providers offices on specifications/measures
Explain/convey technical specifications regarding action plans/follow up
Explain how provider scores are calculated/determined
Demonstrate knowledge of public healthcare insurance industry products(Medicaid
Demonstrate knowledge of Medicaid benefit products including applicable state regulations
Demonstrate knowledge of applicable area of specialization (e.g., OBGYN, Family Practice, Pediatrics, community based services)
Demonstrate knowledge of computer functionality, navigation, and software applications (e.g., Windows, Microsoft Office applications, phone applications, fax server)
Demonstrate knowledge of specific software applications associated with the job function (e.g., navigation of relevant computer applications or systems, intranet databases, records management or claims database
Strong verbal and written communication skills
Ability to work independently
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
More information can be downloaded at: http://uhg.hr/uhgbenefits
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.
High School Diploma/GED
Licensed Practical Nurse (LPN) in the state of Arizona
2+ years medical chart audit experience
2+ years of Clinical Experience
2+ years of experience with Microsoft Office; Word, Excel, Outlook and Teams
1+ years of medical record documentation or review
Ability to travel 50% of the time to provider offices
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
2+ years of experience with a health plan and/or provider office
2+ years of experience with a regulatory contract
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.