Clinical Coding Appeals Nurse

🕒 August 28

🐊 Florida, Kentucky, +4 more states – Remote

🐊 Florida – Remote 🐎 Kentucky – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

💵 $65k - $116.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 13%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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R1 RCM

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

💼 Consulting

📦 Logistics

🏥 Healthcare

💰 Private Equity Round on 2024-07

Consulting • Logistics • Healthcare

R1 RCM is a leading provider of revenue cycle management solutions for the healthcare industry. With an emphasis on maximizing financial performance and optimizing patient care, R1 offers a comprehensive platform that integrates data analytics, intelligent technologies, and deep expertise in revenue cycle management. The company assists healthcare providers—ranging from hospitals and health systems to physician and specialty care practices—in capturing revenue opportunities, improving payer and patient cash flows, and ensuring compliance with government regulations. R1 is committed to driving cost reductions and revenue improvements while enhancing the patient experience. Their suite of services includes revenue recovery, clinical integrity, and regulatory navigation, making them a trusted partner for many top healthcare providers.

📋 Description

• Review and interpret medical records to appeal denied and underpaid claims • Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer or third-party auditor • Draft well-written, logically structured, and persuasive appeal letters using ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance • Review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes • Make coding change suggestions to clients • Complete appeals promptly to meet internal and external compliance deadlines

🎯 Requirements

• Bachelor's Degree in Nursing is required • 5 years of inpatient clinical experience • Certified Coding Specialist (CCS - AHIMA) or Certified Professional Coder (CPC - AAPC) • Active Registered Nurse is strongly preferred • LPNs with acute, inpatient care clinical experience will be considered in place of an RN, based on clinical experience and certifications • Experience identifying hospital documentation including medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters • Proficiency in basic computer skills and MS Office tools, Adobe, and Excel • Knowledge of ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance • Ability to work remotely, independently, and in a production-driven position

🏖️ Benefits

• Annual bonus plan at a target of 10.00% • Competitive benefits package • Opportunity to constantly learn, collaborate across groups, and explore new career paths • Meaningful work and community involvement