Registered Nurse

Description:

We’re looking for a Registered Nurse to join a respected organization consistently recognized as a certified great workplace, known for its strong sense of purpose, inclusive culture, and commitment to employee growth. This full-time, remote role is ideal for individuals who are detail-oriented, thrive in coding/auditing environments, and want to grow within a specialized payment integrity team.

Daily Responsibilities For a Registered Nurse DRG Appeals Reviewer
 

• Review previously denied inpatient claims to confirm the denial was appropriate
• Re-evaluate DRG assignment, coding, and clinical documentation
• Complete detailed appeals reviews when providers dispute the denial
• Use clinical validation guidelines to determine if the original DRG/payment should stand or be adjusted
• Support the clinical review team with high-level claim analysis
   

Benefits
 

• 100% Remote!
• Medical (HDHP) with pharmacy, dental, and vision coverage
• Health Savings Account (HSA) with employer contribution and FSA options
• 100% coverage for imaging, therapy, DME, and home health
• Employee Assistance Program (EAP)
• 401(k) with employer contribution potential
• Basic Life & AD&D, Core LTD, and Buy-Up LTD
• Voluntary Life & AD&D
• Voluntary Accident, Critical Illness, Hospital Indemnity, and Whole Life insurance options
   

Required Qualifications
 

• Active, clear RN license in state of residence
• 2 years recent DRG coding/validation experience
• Ability to review denials and defend findings with documentation
• CIC or CCS required