Senior Clinical Appeals RN – DRG & Payer Appeals Expert

IntelliResume; Minnesota; Remote; USD 100,289,000 - 180,521,000; Full time

Job summary

UnitedHealth Group in Plymouth, MN is seeking a Senior Clinical Appeals RN to review and respond to DRG appeals using ICD-10-CM/PCS coding expertise. This role suits self-motivated problem-solvers who can produce written documentation under tight deadlines.

The position offers full-time day shift work in a on-site setting, with residency requirements for remote work from within the U.S. Must reside in the U.S. for remote opportunities.

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 and ICD-10-PCS coding experience.

Responsibilities

• Analyze scope and resolution of DRG Appeals.
• Respond to Level 1, 2 or higher appeals.
• Perform complex conceptual analyses.
• Identify risk factors, comorbidities, and adverse events.
• Review governmental regulations and payer protocols.
• Research and prepare written appeals.
• Exercise clinical and coding judgment and experience.
• Collaborate with auditors, quality, and leadership teams.

Skills

RN

ICD-10-CM coding

ICD-10-PCS coding

Auditing

Education

Unrestricted RN license in your state of residence

CCS or CIC certification or willing to obtain within 6 months

Job description

UnitedHealth Group in Plymouth, MN is seeking a Senior Clinical Appeals RN to review and respond to DRG appeals using ICD-10-CM/PCS coding expertise. This role suits self-motivated problem-solvers who can produce written documentation under tight deadlines.

The position offers full-time day shift work in a on-site setting, with residency requirements for remote work from within the U.S. Must reside in the U.S. for remote opportunities.