DRG Nurse Reviewer Appeals and Hearings- Remote

We are seeking a talented individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform all appeal related duties including analyzing and responding appropriately to appeals from providers; reviewing documentation to ensure all aspects of the appeal have been addressed properly and accurately; prepare case files and case summaries for hearings; and participate in in virtual and on-site hearings.

Requirements

• Active, Unrestricted RN license from the United States and in the primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), required
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) required
• 5+ years clinical experience or 5+ years medical record coding experience preferred
• Working knowledge of the appeals and hearings process
• Excellent written communication skills including ability to write clear, concise, accurate, and fact-based rationales in support of appeal determinations.
• Excellent oral communication skills with particular emphasis on verbally presenting case summaries and decisions.
• Ability to multi-task in a fast-paced production environment.

Benefits

• Flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance