Senior Clinical Appeals RN

Job Summary

Utilizing expertise in MS-DRG and APR-DRG auditing, the remote Senior Clinical Appeals RN will manage appeals by reviewing medical records, authoring rebuttals, and providing coaching to DRG Validation Specialists while working full-time in a dynamic environment.

Key responsibilities:

• Analyze scope and resolution of DRG Appeals and respond to various levels of appeals
• Collaborate with auditors and leadership to review medical records and determine necessary actions
• Research and prepare written appeals while exercising clinical and coding judgment

Required qualifications:

• Unrestricted RN license in the state of residence
• CCS or CIC certification or willingness to obtain within 6 months of hire
• 2+ years of ICD-10-CM coding experience, including knowledge of diagnosis selection and comorbidities
• 2+ years of ICD-10-PCS coding experience, including knowledge of structural components of PCS