[Remote] Clinical Appeals Auditor - Remote

Note: The job is a remote job and is open to candidates in USA. 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. 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 Skills 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.) 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 Overview Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group. It was founded in 2011, and is headquartered in Eden Prairie, Minnesota, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship Optum has a track record of offering H1B sponsorships, with 648 in 2025, 559 in 2024, 620 in 2023, 851 in 2022, 593 in 2021, 438 in 2020. Please note that this does not guarantee sponsorship for this specific role.