Clinical Appeals Auditor - Remote jobs in United States
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Optum ยท 1 day ago

Clinical Appeals Auditor - Remote

positionUnited States
timeFull-time
remoteRemote
seniorityEntry Level
money$60K/yr - $107K/yr
date1+ years exp

Optum, part of LHC Group, is a leading post-acute care partner dedicated to helping people feel their best. The Clinical Appeals Auditor will ensure clinical documentation meets standards by auditing and appealing records for various health services, while maintaining compliance and protecting reimbursement. This role offers the flexibility to work remotely within the U.S.

EducationHealth CareMedicalPharmaceutical
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H1B Sponsor Likelynote

Responsibilities

Reviews clinical documentation for Home Health, Hospice, LTACHs, and Community-Based Services in response to governmental audits (e.g., ADRs, RACs, CERTs, ZPICs)
Ensures consistency in clinical reviews through standardized processes and high inter-rater reliability
Drafts professional response letters and manages internal determinations for audit appeals
Coordinates and tracks appeal assignments, ensuring deadlines are met and documentation is prepared for Administrative Law Judge hearings
Maintains up-to-date knowledge of federal/state regulations, industry standards, and internal policies related to compliance and reimbursement
Collaborates across departments to minimize operational disruptions and communicate audit trends for corrective action
Supports the Governmental Audit Supervisor with repayment processes and additional compliance audits

Qualification

Nursing degreeLPN licensureClinical documentation auditingReimbursement regulationsMicrosoft Office proficiencyLeadership qualitiesCollaboration skills

Required

Associate's degree in Nursing
Current and unrestricted licensure as a LPN
1+ years of experience in hospice, LTACH, and/or home health care
Working knowledge of reimbursement and compliance regulations
Proficient in Microsoft Office applications (Word, Excel, etc.)

Preferred

Bachelor's degree in Nursing
Experience in auditing and analyzing clinical documentation
Demonstrated leadership qualities
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Benefits

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution

Company

Optum

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Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
dateFounded in 2011
location
Eden Prairie, Minnesota, USA
people-size10001+ employees
web-link
https://www.optum.com/

H1B Sponsorship

Optum has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (648)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)

Funding

Current Stage
Late Stage

Leadership Team

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Daniel Castillo
Chief Executive Officer, Optum Care Delivery
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J
Jay Green
Chief Financial Officer
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Recent News

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2025-11-07
Company data provided by crunchbase