Remote Senior Clinical Appeals RN — DRG & Coding Expert

Texas Health Institute; Plymouth, Northern (MN, KY); Hybrid; USD 100,289,000 - 180,521,000; Full time

Benefits offered by this job

Remote work

Job summary

UnitedHealth Group seeks a Senior Clinical Appeals RN to review DRG Appeals, coach auditors, and provide written appeals. This remote role requires an unrestricted RN license, coding certifications, and 2+ years in ICD-10-CM/PCS.

Responsibilities include analyzing appeals, researching regulations, and collaborating with quality teams to guide decisions. Salary is hourly with strong benefits and telecommuting policy.

Qualifications

• Unrestricted RN license in your state of residence.
• CCS or CIC certification or willing to obtain within 6 months of hire
• 2+ years of ICD-10-CM coding including knowledge of principal diagnosis selection, CCs/MCCs, and SOI/ROM
• 2+ years of ICD-10-PCS coding including body systems, root operations, body parts, approaches, devices, and qualifiers

Responsibilities

• Analyze scope and resolution of DRG Appeals
• Respond to Level one, two or higher appeals
• Perform complex conceptual analyses
• Identify risk factors, comorbidities, and adverse events to determine if overpayment or claim adjustment is needed
• Review governmental regulations and payer protocols or medical policy to recommend actions
• Research and prepare written appeals
• Exercise clinical and/or coding judgment and experience
• Collaborate with existing auditors, quality and leadership to review medical records
• Navigate web-based portals and use MS Word, Excel, and Acrobat
• Serve as a resource on complex issues and help develop innovative solutions
• Define and document / communicate business requirements

Skills

RN license

ICD-10-CM coding

ICD-10-PCS coding

CCS or CIC certification

Education

Coding certifications (RHIT/RHIA/CDIP/CCS/CIC)

Tools

MS Excel

Job description

UnitedHealth Group seeks a Senior Clinical Appeals RN to review DRG Appeals, coach auditors, and provide written appeals. This remote role requires an unrestricted RN license, coding certifications, and 2+ years in ICD-10-CM/PCS.

Responsibilities include analyzing appeals, researching regulations, and collaborating with quality teams to guide decisions. Salary is hourly with strong benefits and telecommuting policy.