DRG Appeals Nurse, RN

🔥 12 hours ago

🏈 Alabama, Alaska, +37 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

📋 Description

• Perform comprehensive reviews of inpatient medical records to validate MS/APR DRGs for Medicare, Commercial, and Third-Party paid claims • Validate ICD-10-CM/PCS codes, discharge disposition codes, HACs, and POA indicators affecting payment • Ensure documentation is clinically supported and follows Official Coding Guidelines, compliant query practices, and current clinical validation criteria • Use audit reference tools and applications, including proprietary denials management software, TruCode, and 3M encoder and grouper software • Review denial-letter rationales and formulate custom appeal response letters • Independently assess appeal cases for strengths and weaknesses • Construct and document fact-based cases using clinical evidence, industry clinical guidelines, evidence-based medicine, and official coding guidelines • Write professional appeal letters supporting each appeal argument • Abstract denial audit findings into the proprietary application according to standard procedures • Maintain subject-matter expertise in clinical validation, ICD-10-CM/PCS code sets, coding guidelines, clinical documentation integrity, and inpatient payment methodologies • Attend continuing education workshops and webinars • Meet production and quality expectations while performing complex medical record audits • Perform other assigned responsibilities

🎯 Requirements

• Current and valid RN license in good standing • Professional RN license must be maintained as a condition of employment • Minimum of 5 years of experience in inpatient coding quality assurance, DRG validation, DRG appeal, or Clinical Documentation Integrity as a Clinical Documentation Specialist, Educator, or Manager • DRG validation experience • Medical necessity experience and appeal letter writing • Extensive inpatient coding skills • Regulatory ICD-10-CM/PCS coding expertise • Subject matter expertise in MS/APR DRG payment methodologies, including HACs, POA assignment, and discharge disposition codes • Clinical validation expertise, including current industry-standard clinical indicators, risk factors, and treatment protocols • Knowledge of anatomy, physiology, pathology, laboratory, imaging, pharmacology, disease assessment, management, and treatment • Strong critical thinking skills • Excellent written and verbal communication skills • Proficiency in Microsoft Office, Teams, WebEx, VPN access, various EHRs, and Internet connectivity troubleshooting • Coding certification (AHIMA or AAPC) is a plus • CCS preferred after one year of employment • RHIT/RHIA/CPC is a plus • CDIP or CCDS highly preferred • Ability to work at a computer terminal for 6–8 hours a day • Ability to lift and move material weighing up to 20 lbs. infrequently

🏖️ Benefits

• Competitive salary • Bonus opportunities • Medical, Dental, and Vision coverage • 401K • Holidays • Paid time off • Short-term and long-term disability insurance • Life insurance • Reimbursement for continuing education and association dues • Predictable schedule • Flexible work environments • Professional development and personal growth opportunities