Clinical Appeals Nurse & Coding Specialist - Remote Opportunity

Are you a skilled healthcare professional with a passion for accuracy and a commitment to improving patient outcomes? Join our dynamic team at Workwarp, a leading healthcare technology company, as a Clinical Appeals Nurse & Coding Specialist! This is a fantastic opportunity to leverage your clinical expertise and coding proficiency in a fully remote role, making a real difference in the lives of millions.

About Workwarp & Our Mission

Workwarp is a global organization dedicated to empowering healthcare providers with innovative technology and expert support. We believe that technology, combined with human insight, can transform healthcare delivery and improve patient lives. As part of our team, you'll play a vital role in ensuring the accuracy and integrity of patient claims, ultimately contributing to better financial outcomes for healthcare providers and improved access to care for patients.

We foster a collaborative and supportive environment where talented individuals can thrive. You'll benefit from comprehensive benefits, opportunities for professional growth, and a culture that values diversity and inclusion. This is more than just a job – it's a chance to make a meaningful impact on the healthcare landscape.

The Role: Clinical Appeals Nurse & Coding Specialist

As a Clinical Appeals Nurse & Coding Specialist, you will be a key member of our appeals team, responsible for the accurate and efficient review and processing of patient appeals. You'll combine your clinical knowledge with your coding expertise to craft compelling and defensible appeals, ensuring that patients receive the appropriate level of care and reimbursement. This role requires a highly motivated, detail-oriented individual who can work independently and as part of a team in a fast-paced environment.

Core Responsibilities:

• Comprehensive Medical Record Review: Thoroughly review patient medical records to extract pertinent clinical information, including diagnoses, procedures, and supporting documentation.
• Defensible Appeal Letter Creation: Develop well-written, accurate, and persuasive appeal letters based on established guidelines, clinical evidence, and coding principles.
• Coding Expertise: Utilize your knowledge of ICD-10-CM, CPT, and HCPCS coding systems to assign appropriate codes that accurately reflect the patient's condition and treatment.
• Compliance & Accuracy: Ensure all appeals adhere to OpTum and OPAS policies, procedures, and regulatory guidelines.
• Clinical Summary Creation: Compile clear and concise clinical summaries of patient cases for efficient appeal processing.
• Appeal Strategy & Argumentation: Identify and leverage relevant medical literature and clinical guidelines to support appeal arguments.
• Collaboration & Communication: Work closely with physicians, operations teams, intake specialists, and leadership to ensure seamless appeal processing.
• Quality Assurance: Conduct thorough reviews of completed appeals to ensure accuracy, completeness, and adherence to quality standards.
• Process Improvement: Identify opportunities to improve appeal processes and contribute to team knowledge sharing.
• Administrative Law Judge (ALJ) Support: Participate in ALJ hearings, providing expert clinical and coding testimony when required.
• Data Entry & System Utilization: Accurately enter clinical and coding information into OPA's clinical database and utilize relevant IT platforms.
• Continuous Learning: Stay up-to-date on coding changes, medical guidelines, and industry best practices.
• HIPAA Compliance: Maintain strict confidentiality of patient information in accordance with HIPAA regulations and company policies.
• Time Management & Productivity: Manage time effectively to meet deadlines and achieve productivity goals while maintaining high quality standards.
• Proactive Issue Reporting: Identify and report any issues that may impact productivity or quality to the appropriate supervisor.
• Team Collaboration: Actively participate in team meetings, training sessions, and knowledge-sharing activities.
• Support Other Departments: Assist other departments as needed to ensure smooth operational flow.

Qualifications:

• High school diploma or equivalent required; Bachelor's degree preferred.
• Minimum of 1 year of inpatient hospital coding experience.
• Minimum of 1 year of experience with DRG methodology.
• Minimum of 3 years of outpatient coding experience.
• Certification in one or more of the following coding areas: CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDI, CCDS.
• Demonstrated mastery of AHA Coding Clinic for ICD-10-CM and ICD-9-CM.
• Experience with Medicare/Medicaid billing and coding regulations.
• Experience with auditing healthcare claims.
• High degree of computer proficiency, including typing skills (minimum 45 WPM).
• Proficient in Microsoft Office Suite and internet navigation.
• Ability to work a standard work schedule (7:30 AM - 4:30 PM EST).

Preferred Qualifications:

• Active Registered Nurse (RN) license.
• Strong understanding of and adherence to HIPAA confidentiality requirements.
• Experience presenting information to executive-level stakeholders (e.g., Judges, Attorneys).

The Work Environment:

This is a fully remote position, offering the flexibility to work from the comfort of your own home. You will be required to have a dedicated, quiet workspace that ensures information privacy and the ability to securely store company-sensitive documents. A reliable high-speed internet connection is essential.

Benefits & Compensation:

We offer a comprehensive benefits package, including medical, dental, and vision insurance, paid time off, retirement savings plan with company match, and opportunities for professional development. Salary ranges from $22.45 to $43.89 per hour, commensurate with experience and qualifications. Additional benefits such as incentive programs, equity stock purchase, and 401k contributions are also available.

Join Our Team!

If you are a dedicated and skilled healthcare professional seeking a rewarding remote opportunity, we encourage you to apply! At Workwarp, you'll be part of a team that is passionate about improving healthcare and making a difference in the lives of patients.

Workwarp is an Equal Employment Opportunity / Affirmative Action employer. We are committed to creating a diverse and inclusive workplace and do not discriminate on the basis of race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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