Remote Clinical Coding Appeals Nurse Medical Claims Expert

R1 RCM; United States; On-site; USD 65,000 - 117,000; Full time

Job summary

R1 RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals of denied and underpaid claims.

You will ensure correct coding, draft persuasive appeal letters, and provide coding change recommendations based on ICD-9/10-CM, PCS, CPT, HCPCS, and NCCI guidelines. The role requires reviewing diverse hospital documentation, with MS Office proficiency, and offers a remote, independent, production-driven work environment.

Qualifications

• Bachelor's Degree in Nursing is required.
• 5 years of inpatient clinical experience.
• Certified Coding Specialist (CCS - AHIMA) or Certified Professional Coder (CPC - AAPC).
• Active Registered Nurse is strongly preferred. (LPNs with acute inpatient care 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 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

CCS - AHIMA

CPC - AAPC

Active RN preferred

Education

Bachelor's Degree in Nursing

Tools

MS Office

Adobe

Excel

Job description

R1 RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals of denied and underpaid claims.

You will ensure correct coding, draft persuasive appeal letters, and provide coding change recommendations based on ICD-9/10-CM, PCS, CPT, HCPCS, and NCCI guidelines. The role requires reviewing diverse hospital documentation, with MS Office proficiency, and offers a remote, independent, production-driven work environment.