Clinical Coding Appeals Nurse
About The Position
R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. 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. Then you will draft appeal letters based on clinical judgment and knowledge and make coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. To thrive in this role, you must have experience identifying different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters. Proficiency in basic computer skills (proficiency in MS office tools - Adobe, Excel) is essential for excelling in this remote, independent, production-driven position.
Requirements
- 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 in place of an RN, based on clinical experience and certifications).
- Proficiency in basic computer skills (proficiency in MS office tools - Adobe, Excel) is essential.
- Experience identifying different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters.
Responsibilities
- Review and interpret medical records to appeal denied and underpaid claims.
- Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer or third-party auditor.
- Draft appeal letters that are well-written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance.
- Ensure that all appeals are completed promptly to ensure internal and external compliance deadlines are met.
Benefits
- annual bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
