Remote Clinical Coding Appeals Nurse

R1 RCM; Georgia; Hybrid; USD 65,000 - 117,000; Full time

Benefits offered by this job

Remote work options

Job summary

R1 RCM is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals for denied or underpaid claims. You will apply clinical judgment across ICD-9/10-CM & PCS, CPT, HCPCS, and NCCI guidance while ensuring timely appeals and compliance.

Strong MS Office skills are essential for this remote role. The position requires a Nursing degree with 5 years of inpatient experience and CCS or CPC certification; RN status is strongly preferred.

Qualifications

• Bachelor's Degree in Nursing required.
• At least 5 years of inpatient clinical experience.
• CCS (AHIMA) or CPC (AAPC) certification required.
• Active Registered Nurse status preferred; LPNs with relevant experience considered.

Responsibilities

• Review and interpret medical records to appeal denied and underpaid claims.
• Apply clinical judgment for DRG downgrades after Clinical Validation Review.
• Draft persuasive appeal letters using ICD-9/10-CM/PCS, CPT, HCPCS, and NCCI guidance.
• Ensure all appeals meet internal and external deadlines.

Skills

Nursing degree

Inpatient clinical experience

CCS or CPC certification

RN preferred

Education

Bachelor's Degree in Nursing

Tools

MS Office

Adobe

Excel

Job description

R1 RCM is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals for denied or underpaid claims. You will apply clinical judgment across ICD-9/10-CM & PCS, CPT, HCPCS, and NCCI guidance while ensuring timely appeals and compliance.

Strong MS Office skills are essential for this remote role. The position requires a Nursing degree with 5 years of inpatient experience and CCS or CPC certification; RN status is strongly preferred.