This is a fully remote position, open to applicants in Florida, +5 more states.

📋 Description

• Evaluate and analyze medical records to challenge denied and underpaid claims.

• Utilize clinical expertise and knowledge for DRG downgrades resulting from a Clinical Validation Review conducted by an insurer or third-party auditor.

• Compose well-structured, compelling appeal letters adhering to ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidelines.

• Examine medical records to verify proper coding of altered or removed diagnosis and procedure codes.

• Offer coding modification recommendations to clients.

• Finalize appeals swiftly to comply with both internal and external deadlines.

⛳️ Requirements

• A Bachelor's Degree in Nursing is mandatory.

• Minimum of 5 years of inpatient clinical experience is required.

• Certification as a Certified Coding Specialist (CCS - AHIMA) or Certified Professional Coder (CPC - AAPC) is necessary.

• An active Registered Nurse license is highly preferred.

• LPNs with experience in acute, inpatient care will be considered instead of an RN, depending on clinical experience and certifications.

• Experience in identifying hospital documentation such as medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters is essential.

• Proficiency in basic computer skills along with MS Office applications, Adobe, and Excel is required.

• Familiarity with ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidelines is important.

• Capability to work remotely and independently in a production-focused environment is necessary.