Clinical Coding Appeals Nurse
Location: Remote, USA
Employment Type: Full time
Job ID: R240000002599
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 combine 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. You will review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes. 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 is essential for excelling in this remote production-driven position.
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 timely to ensure internal and external compliance deadlines are met.
Required Skills:
- Active Registered Nurse license
- Active AHIMA or AAPC Coding Certification including CCS, RHIA, RHIT, CCA, CPC-A, CPC-H (COC), CPMA, CIC, CDI, or CDIP
For this US-based position, the base pay range is $71,930.00 – $109,236.00 per year. Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.
The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team, you’ll find the opportunity to constantly learn, collaborate across groups, and explore new paths for your career. Our associates are given the chance to contribute, think boldly, and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do, driving customer success and improving patient care while giving back to the community and taking care of our team — including offering a competitive benefits package.
R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. The Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.
If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.
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