As our Clinical Coding Appeals Nurse, you will help review and interpret medical records to draft appeals of denied and underpaid claims. Every day you will:
Review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes.
Draft appeal letters based on clinical judgment and knowledge.
Make coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance.
Identify different types of hospital documentation including medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters.
Utilize basic computer skills (proficiency in MS Office tools - Adobe, Excel).
Qualifications
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 based on clinical experience and certifications).
Requirements
Ability to apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer or third-party auditor.
Ensure that all appeals are completed promptly to meet internal and external compliance deadlines.
Benefits
Base pay range is $65,000.00 - $116,747.20 per year.
Eligible to participate in our annual bonus plan at a target of 10.00%.