Job Description
Job Description:
Title: Clinical Nurse Specialist Remote
REQUIRED: ACTIVE RN LICENSE (multi-state preferred)
Key Responsibilities:
- Perform clinical coding and DRG validation for various service types.
- Review claims for accuracy and severity of stay based on appropriate diagnosis codes.
- Apply CMS guidelines, state policies, and payer requirements in coding processes.
- Support appeals and reconsiderations, including Medicaid-related cases.
- Collaborate with vendors and internal teams on coding and editing systems.
- Ensure compliance with coding certifications and payer policies.
Qualifications:
- Active RN license (multi-state preferred) OR Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), CPC, CSS, RHIT, or equivalent credential.
- Minimum 3 5 years of experience in clinical coding and DRG validation.
- Strong knowledge of CMS guidelines, payer policies, and therapy benefit structures.
- Experience with reconsiderations, appeals, and code editing (CPC experience preferred).
- Medicaid experience strongly preferred.
- Ability to teach systems and code editor tools; prior coding experience required.
Preferred Skills:
- Familiarity with state-specific coding policies and written guidelines.
- Knowledge of all service types and payer structures.
- Strong analytical and organizational skills.
- Years of Experience:3.00 Years of Experience
Job Tags
Remote work,