Clinical Coding Appeals Nurse

About the role

R1 is a provider of technology-driven solutions for hospitals, health systems and medical groups, combining revenue cycle professionals with an advanced technology platform. As a Clinical Coding Appeals Nurse in this remote, independent, production-driven position, you will review and interpret medical records to draft appeals of denied and underpaid claims, and suggest coding changes to clients.

Key responsibilities

• Review and interpret medical records to appeal denied and underpaid claims.
• Ensure appropriate coding of removed or revised diagnosis and procedure codes.
• Apply clinical judgment to DRG downgrades performed after a Clinical Validation Review by an insurer or third-party auditor.
• Draft well-written, logically structured appeal letters using ICD-9/10 CM & PCS, CPT, HCPCS and NCCI guidance.
• Make coding change suggestions to clients based on ICD-9/10 CM & PCS, CPT, HCPCS and NCCI guidance.
• Complete all appeals promptly so internal and external compliance deadlines are met.

Required profile

• Bachelor's degree in Nursing.
• 5 years of inpatient clinical experience.
• Certified Coding Specialist (CCS, AHIMA) or Certified Professional Coder (CPC, AAPC).
• Active Registered Nurse strongly preferred; LPNs with acute, inpatient care experience may be considered instead of an RN.
• Experience identifying hospital documentation such as medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters and denial/approval letters.

Required skills

• Proficiency in MS Office tools, including Adobe and Excel.
• Knowledge of ICD-9/10 CM & PCS, CPT, HCPCS and NCCI coding guidance.

What we offer

• Base pay range of $65,000 to $116,747.20 per year, depending on role, level, location, skills and experience.
• Eligibility for an annual bonus plan at a target of 10%.
• Competitive benefits package.