This position will be an in office role in 1 East Washington Street, Phoenix, AZ and will require 60% travel to provider offices.
Schedule will be Monday-Friday.
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.
Functional Competency & Description
- 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
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 or more years of Clinical Experience
- 1 or more years of Medical record documentation or review
- Computer Proficiency - Microsoft Office; Word, Excel, Outlook and Teams
- Ability to travel 60% of the time to provider offices
- You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations.
- Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
- Previous work experience with a health plan and/or provider office
- Previous work experience with a regulatory contract
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)
UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.
Some of the steps we've taken to ensure employee well-being include:
- Launched our ProtectWell app and UnitedCARES program to help ease the burden and stress for our UnitedHealth Group team members and their immediate family affected by COVID-19
- Daily updates from our CEO Dave Wichmann to support and inspire team members during this challenging time
- Onsite social distancing and increased sanitization measures for employees who have been welcomed back to our offices
- Fully cover the COVID-19 healthcare costs for our employees
- Employees who self-identify as high risk or who live with someone who is high risk have been asked to remain working from home
You can learn more about all we are doing to fight COVID-19 and support impacted communities at: click here.
What we do defines who we are. Take a deeper look at how we're providing support during this global health crisis and search for a way you can get involved. View our COVID-19 Resources Page: click here.
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.
Job Keywords: Medical Record Auditor, Medical records, LPN, United Healthcare, Phoenix, AZ, Arizona, hiring immediately