[Hiring] Clinical Coding Appeals Nurse @R1 RCM

Role Description

As our Clinical Coding Appeals Nurse, you will help review and interpret medical records to draft appeals of denied and underpaid claims. Every day you will:

• Review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes.
• Draft appeal letters based on clinical judgment and knowledge.
• Make coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance.
• Identify different types of hospital documentation including medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters.
• Utilize basic computer skills (proficiency in MS Office tools - Adobe, Excel).

Qualifications

• Bachelor's Degree in Nursing is required.
• 5 years of inpatient clinical experience.
• Certified Coding Specialist (CCS - AHIMA) or Certified Professional Coder (CPC - AAPC).
• Active Registered Nurse is strongly preferred (LPNs with acute, inpatient care clinical experience will be considered based on clinical experience and certifications).

Requirements

• Ability to apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer or third-party auditor.
• Ensure that all appeals are completed promptly to meet internal and external compliance deadlines.

Benefits

• Base pay range is $65,000.00 - $116,747.20 per year.
• Eligible to participate in our annual bonus plan at a target of 10.00%.
• Competitive benefits package.