State Licensed Nurse Coder

Job Summary

As a Subject Matter Expert, the full-time remote State Licensed Nurse Coder will independently audit outpatient and inpatient claims, validate coding accuracy, and provide strategic recommendations while ensuring compliance with industry standards.

Key responsibilities

• Utilize coding and clinical guidelines to validate DRG or APC claims and ensure compliance with CMS and payer regulations
• Independently perform quality checks for team members and provide appeal responses for claims
• Execute strategic decision-making and support management with enterprise-level recommendations

Required qualifications

• An active RN professional license in good standing
• Coding certification in good standing (e.g., CCS, CIC)
• Clinical practice experience and coding validation/auditing experience
• Proficiency in Microsoft Office, specifically Excel
• Well-developed verbal and written communication skills