[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.
