Senior Clinical Appeals RN
Job Summary
Utilizing expertise in MS-DRG and APR-DRG auditing, the remote Senior Clinical Appeals RN will analyze DRG appeals, respond to various levels of appeals, and provide coaching to DRG Validation Specialists while working in a flexible, full-time capacity.
Key responsibilities
- Analyze scope and resolution of DRG Appeals
- Respond to Level one, two, or higher appeals and perform complex conceptual analyses
- Collaborate with auditors and leadership to review medical records pertaining to impacted claims
Required qualifications
- Unrestricted RN (registered nurse) license in your 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/comorbidities
- 2+ years of ICD-10-PCS coding experience, including knowledge of structural components of PCS
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