Clinical Coding Appeals Nurse

As our Clinical Coding Appeals Nurse, you will help review and interpret medical records to draft appeals of denied and underpaid claims. Every day you will review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes. Then you will draft appeal letters based on clinical judgment and knowledge and make coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. To thrive in this role, you must have experience identifying different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters. Proficiency in basic computer skills (proficiency in MS office tools - Adobe, Excel) is essential for excelling in this remote, independent, production-driven position.

Here's what you will experience working as a Clinical Coding Appeals Nurse

• Review and interpret medical records to appeal denied and underpaid claims.
• Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer or third-party auditor.
• Draft appeal letters that are well-written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance.
• Ensure that all appeals are completed promptly to ensure internal and external compliance deadlines are met.

Required Skills

• 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 clinical experience will be considered in place of an RN, based on clinical experience and certifications).

For this US-based position, the base pay range is $65,000.00 - $116,747.20 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

This job is eligible to participate in our annual bonus plan at a target of 10.00%