Remote M&R Clinical Investigator (Claims Audit)
UnitedHealth Group
UnitedHealth Group is seeking a M&R Clinical Investigator to verify claim accuracy by comparing provider medical records to submitted claims. The role supports pre-payment reviews in a telecommuting setup, requiring coding expertise and healthcare regulatory knowledge. You will analyze complex cases, interact with clinical staff, and meet production and quality targets in a supportive, compliant environment. #J-18808-Ljbffr
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote M&R Clinical Investigator (Claims Audit) in Minneapolis, MN vacancy
$24 - $43 per hour
...M&R Coding Clinical AnalystOptum is a global organization that... ...determine the accuracy of claims submitted by a... ...They are responsible to investigate, review and provide... ...decisions on complex cases.Remote: You'll enjoy the... ...:Performs quality audits of clinical review cases...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLocal areaUnitedHealthcare At Home
Minneapolis, MN4 days ago- ...Optum is seeking a skilled M&R Clinical Investigator to verify claims against medical records. You will review CPT/HCPCS/ICD codes, ensure compliant coding, and support pre-payment decisions in a telecommuting setup across the United States, with strong collaboration...Remote workClaimsFlexible hours
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Virtual Vocations Inc
United States5 days ago $65.97k - $124.99k
...healthcare services provider is seeking a Clinical Fraud Investigator II, requiring an Associate Degree in... ...clinical data, investigating claims for compliance, and collaborating with... ...fraud investigation. This role offers remote work flexibility within certain commuting...Remote workClaimsElevance Health
United States4 days ago$78k - $113k
...general direction from the SIU Director, the Clinical Investigator II serves as the Special Investigations... ...provider investigations and medical audits, and collaborates with regulatory... ...Partners with internal departments (e.g., Claims, Medical Management, Legal, Provider Relations...ClaimsFull timeFixed term contractWork at officeFlexible hours$96k - $132k
...Clinical Investigator (Solventum) At Solventum, we enable better, smarter, safer healthcare to improve... ...Eligible (Job Duties allow for some remote work but require travel to Eagan, MN... ...postings and recruitment schemes that falsely claim to represent Solventum and seek to...Remote workClaimsH1bRelocation packageFlexible hours3 days per week- ...Optum is seeking a Clinical DRG RN auditor who will validate ICD-10-CM/PCS codes and DRG assignments for inpatient claims. You will write clear rationales and use proprietary tools to... ...accurate reimbursements.The role supports remote work from anywhere in the U.S. and...Remote workClaims
University of Minnesota School of Nursing
Minneapolis, MN4 days ago - ...Sedgwick is seeking a clinical reviewer to perform standard evaluations on disability claims, consult with providers, and ensure medical... ...and maintain high-quality audit scores while traveling as required... .... The role offers full-time remote work with opportunities to contribute...Remote workClaimsFull time
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United States2 days ago $60.1k - $98.7k
...getting the details right? Join EXL as a Clinical Validation Auditor and help ensure medical claims are coded accurately and fairly. This is a fully remote position where you’ll use your... ...onsite engagements.) A brief coding/auditing assessment may be included as part...Remote workClaimsFull time$45k - $65k
...data analytics, technology solutions, audit, investigation, and medical review. At IntegrityM,... ...skills. Experience reviewing healthcare claims, enrollment records, medical records,... ...plan, and educational benefits. U.S. remote annual salary range: $45,000-$65,000/...Remote workClaimsFull timeContract workTemporary workWork at officeLocal areaFlexible hours- TalentLNX LLC seeks a remote Clinical Claims Review RN to audit hospital claims line by line against medical records, ensuring charges are ordered, documented, and supported. The role blends acute care nursing judgment with chart auditing, coding, and revenue integrity...Remote jobClaims
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United States2 days ago- ...classified as hybrid, onsite or remote. Hybrid Individual... ...limited to: Customer Service, Claims Processors, and Correspondence... ...within the State of Arizona. The Clinical Trainer and Auditor is responsible... ...in NCQA Surveys, CMS Program Audit, and/or AHCCCS Operational Review...Remote workClaimsFull timeWork experience placement1 day per week
Blue Cross Blue Shield of Arizona
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$90k - $100k
...Response Center through a 100% remote work arrangement. This... ...internal control reviews, quality audits, and program integrity initiatives... ...include: Support federal investigators and subject matter experts in... .... Background in healthcare claims, payment integrity, improper...Remote workClaimsShift workZachary Piper
Richmond, VA3 days ago- ...Clinical Audit/Validation Specialist Performs clinical audit/validation... ...and retrospective medical claims audit criteria, and clinical... ...is Not Patient Facing Remote Work Guidelines Workspace... ...participates in a discrimination investigation, or otherwise opposes an...Remote workClaims
$69.4k - $99.2k
...analytic models to Medicaid claims data and delivering monthly,... ...up questions, and supporting investigations through data analysis, documentation... ...investigative outcomes, and audit results into recommendations... ...activities (Up to 25%) Fully remote opportunity with the option...Remote workClaimsFull timeWork at officeFlexible hours- ...Health Plan (PCHP) Special Investigations Unit is to implement an effective... ..., and abuse violations. The Clinical SIU Investigator ensures... ...organization or medical record auditing is preferred. Equivalent... ...based on medical records, claim history, billing codes, regulatory...ClaimsWork at office
Parkland Health and Hospital System
Dallas, TX1 day ago $129.2k - $168k
...Utilization Management (UM), Claims, and Appeals & Grievances—to ensure... ..., this role provides direct clinical monitoring leadership by... ...conducts risk-based operational audits, assesses alignment with clinical... .... Additionally, we embrace a remote-first culture that supports collaboration...Remote workClaimsFull timeWork experience placementWork at officeFlexible hours- ...Description Job Description The APWU Health Plan is seeking a FWA Clinical Investigator to join our Finance and Administration Division. This position audits clinical documentation and healthcare claims to identify billing irregularities, coding inaccuracies, and...ClaimsWork at office
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on... ...Validation primarily performs medical claims audit reviews. As a MR Nurse, you will join a... ...Government and Commercial Payers. You will work remotely in a fast paced and dynamic environment...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work- ...Supervisor on our Mobile Clinic Operations Team. As... ...safety, and regulatory audit readiness. Primary... ...accidents; coordinate with Claims, Legal, and Safety... ...(NACI) background investigation Preferred Qualifications... ...) Job Location: Remote Travel requirements...Remote workClaimsContract workImmediate startFlexible hoursWeekend work
GrabJobs
Hampton, VA3 days ago $87k - $105k
...Senior Clinical ManagerRespire Homecare Services provides comprehensive... ...digital huddles, and regular remote touchpoints across your... ...— training, onboarding, chart audits, and KPI performance. Champion... ...changes in patient profiles, CMNs, claim files, scheduled deliveries, and...Remote workClaimsWork at officeLocal areaShift workRespire Homecare
Charlotte, NC2 days ago$35 - $63 per hour
...together.In this position as a Clinical DRG RN auditor, you will... ...Clinic Guidelines in the auditing of inpatient claims. Employing both industry... ...and expertise to the other investigative and analytical areasWork... ...to work independently in a remote environment and deliver exceptional...Remote workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaUniversity of Minnesota School of Nursing
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Rialtic
New York, NY3 days ago
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