Remote Clinical Coding Appeals Nurse

R1 RCM; Salt Lake City (UT); On-site; USD 65,000 - 117,000; Full time

Benefits offered by this job

Annual bonus

Job summary

R1 RCM is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals for denied or underpaid claims from a remote US position. You will determine proper coding for revised diagnoses and procedures and draft persuasive appeals using ICD-9/10-CM/PCS, CPT, HCPCS, and NCCI guidance.

You will need 5 years of inpatient clinical experience, an active RN license (CCS or CPC certifications preferred), and proficiency with MS Office tools.

Qualifications

• Bachelor's Degree in Nursing is required.
• 5 years of inpatient clinical experience.
• CCS (AHIMA) or CPC (AAPC) certification.
• Active RN license preferred; LPNs with relevant experience may be considered.

Responsibilities

• Review and interpret medical records to appeal denied or 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

Inpatient clinical experience

Registered Nurse (RN) license

CCS (AHIMA)

CPC (AAPC)

MS Office (Adobe, Excel)

Education

Bachelor's Degree in Nursing

Tools

MS Office

Job description

R1 RCM is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals for denied or underpaid claims from a remote US position. You will determine proper coding for revised diagnoses and procedures and draft persuasive appeals using ICD-9/10-CM/PCS, CPT, HCPCS, and NCCI guidance.

You will need 5 years of inpatient clinical experience, an active RN license (CCS or CPC certifications preferred), and proficiency with MS Office tools.