State Licensed Senior Clinical Appeals RN

A company is looking for a Senior Clinical Appeals RN.

Key Responsibilities

Analyze and respond to DRG appeals, including complex conceptual analyses

Review medical records and collaborate with auditors to determine overpayment or claim adjustments

Prepare written appeals and provide coaching to remote DRG Validation Specialists

Required Qualifications

Associate's degree (or higher)

Unrestricted RN license in the state of residence

3+ years of MS DRG / APR DRG coding experience in a hospital environment

Advanced proficiency with ICD-10-CM and ICD-10-PCS coding

CCS or CIC certification or ability to obtain within 6 months of hire