Senior DRG Appeals RN - Remote Coding Expert

UnitedHealth Group; Plymouth (MN); Remote; Confidential; Full time

Job summary

UnitedHealth Group is seeking a Senior Clinical Appeals RN to review and respond to DRG appeals. You will analyze complex coding factors, collaborate with auditors, and provide guidance to DRG Validation Specialists. This remote role supports the U.S.

healthcare system by ensuring accurate reimbursements and compliant processes. The position requires an unrestricted RN license, coding certifications (or willingness to obtain), and 2+ years of ICD-10-CM/PCS experience.

Qualifications

• RN license in your state
• CCS or CIC certification or willingness to obtain within 6 months
• 2+ years of ICD-10-CM coding experience with knowledge of diagnoses and COMORBIDITIES
• 2+ years of ICD-10-PCS coding experience 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 affecting overpayment or adjustments
• Review governmental regulations and payer protocols to recommend actions
• Research and prepare written appeals
• Exercise clinical and coding judgment
• Collaborate with auditors, quality and leadership to review medical records
• Navigate portals and use MS Word, Excel, Adobe
• Serve as a resource on complex issues and develop solutions
• Define and document business requirements

Skills

Clinical coding aptitude

Analytical thinking

Problem solving

Communication

Education

RN license

CCS or CIC certification or willingness to obtain within 6 months

MS DRG/APR DRG coding experience in hospital

Tools

MS Excel

Job description

UnitedHealth Group is seeking a Senior Clinical Appeals RN to review and respond to DRG appeals. You will analyze complex coding factors, collaborate with auditors, and provide guidance to DRG Validation Specialists. This remote role supports the U.S.

healthcare system by ensuring accurate reimbursements and compliant processes. The position requires an unrestricted RN license, coding certifications (or willingness to obtain), and 2+ years of ICD-10-CM/PCS experience.