Senior Clinical Appeals RN
Job Summary
Utilizing expertise in MS-DRG and APR-DRG auditing, the remote Senior Clinical Appeals RN will analyze and respond to appeals, coach DRG Validation Specialists, and provide written documentation under tight deadlines.
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 principal diagnosis selection and complications
- 2+ years of ICD-10-PCS coding experience, including knowledge of structural components of PCS
Complete Job Description
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