Home Health/Hospice Clinical Appeals Auditor - LPN

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Home Health/Hospice Clinical Appeals Auditor - LPN

@ LHC Group

Explore opportunities with Home Office, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.

As a Governmental Audit Reviewer, you are the expert who ensures clinical documentation stands up to scrutiny. You take the lead in auditing, submitting, and appealing records for home health, hospice, LTACHs, and community-based services. When external payers come calling-whether it's ADRs, CERTs, RACs, ZPICs, or other audits-you're ready. You dive into the details, respond with precision, and defend the integrity of care through every pre- and post-payment review. Your work protects reimbursement, supports compliance, and keeps the organization audit-ready at all times.

Primary 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

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.

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Qualifications:

Required Qualifications:

• 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 Qualifications:

• Bachelor's degree in Nursing
• Experience in auditing and analyzing clinical documentation
• Demonstrated leadership qualities

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How to Apply:

Apply online at: https://careers.unitedhealthgroup.com/search-jobs 

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