Clinical Coding Appeals Nurse

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 is essential for excelling in this remote production-drive position.

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.