You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities
- Provide coordination of the Recovery Audit Contractor (RAC) audit program, ensuring compliance with regulatory requirements and organizational standards
- Collaborate with Health Information Management (HIM), Coding, Revenue Cycle, Case Management, Physicians, and Financial Services departments
- Review, respond to, track, and monitor Medicare audits and payment reviews through final resolution
- Manage audit planning, scheduling, reporting, content management, and adherence to established audit standards and procedures
- Analyze RAC and payer audit findings to identify trends, risks, and opportunities for revenue cycle improvement
- Create and implement process improvement initiatives using trend analysis and predictive modeling to reduce audit exposure and financial risk
- Coordinate RAC requests, appeals, documentation submissions, and response timelines to ensure compliance with payer deadlines
- Track audit inventories and maintain accurate records of audit activities, outcomes, recoveries, and appeals
- Updating regulatory checklists for audit reviews (internal use only)
- Develop and deliver internal education and training programs related to audit readiness, documentation, coding, and compliance standards
- Communicate audit findings, trends, and recommendations to executive leadership, including the Chief Financial Officer (CFO) and departmental stakeholders
- Apply knowledge of medical coding, billing regulations, appeals processes, and Medicare requirements to support successful audit outcomes
Required Qualifications
- RN license in your state of residence, or BSN status
- 3+ years of experience performing healthcare audits, appeals and discussions within a hospital or healthcare environment
- 3+ years of experience in medical coding, billing practices, reimbursement methodologies, and Medicare processes
- 3+ years of experience with appeals
- Intermediate proficiency in Microsoft Office
Soft Skills
- Strong communication skills
- Strong analytical, project management, reporting, and communication skills
- Ability to identify trends, manage multiple deadlines, and lead cross-functional initiatives
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
The salary for this role will range from $60,200 to $107,400 annually based on full-time employment.