R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.
As our Clinical Coding Appeals Nurse, you will help review and interpret medical records to draft appeals of denied and underpaid claims. Every day you will review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes. Then you will draft appeal letters based on clinical judgment and knowledge and make coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. To thrive in this role, you must have experience identifying different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters. Proficiency in basic computer skills (proficiency in MS office tools - Adobe, Excel) is essential for excelling in this remote, independent, production-driven position.
Here’s what you will experience working as a Clinical Coding Appeals Nurse:
Review and interpret medical records to appeal denied and underpaid claims.
Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer or third-party auditor.
Draft appeal letters that are well-written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance.
Ensure that all appeals are completed promptly to ensure internal and external compliance deadlines are met.
Required Skills:
Bachelor's Degree in Nursing is required.
5 years of inpatient clinical experience
Certified Coding Specialist (CCS - AHIMA) or Certified Professional Coder (CPC - AAPC)
Active Registered Nurse is strongly preferred. (LPNs with acute, inpatient care clinical experience will be considered in place of an RN, based on clinical experience and certifications).
The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.
Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.
R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.
If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.
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Skills Required
- Bachelor's degree in Nursing
- Five years of inpatient clinical experience
- Certified Coding Specialist certification from AHIMA or Certified Professional Coder certification from AAPC
- Active Registered Nurse license
- Licensed Practical Nurse with acute inpatient clinical experience may be considered in place of an RN, based on clinical experience and certifications
- Experience identifying and interpreting hospital documentation, including medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial or approval letters
- Proficiency with basic computer skills and Microsoft Office, Adobe, and Excel
R1 RCM Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about R1 RCM and has not been reviewed or approved by R1 RCM.
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Leave & Time Off Breadth — Flexible or unlimited PTO, paid holidays/vacation, and paid volunteer time are highlighted, supporting work-life balance in many roles. Time-off usability is described as workable in many teams, especially in exempt roles.
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Flexible Benefits — Remote work options and flexible schedules are available for many positions, offering convenience and adaptability depending on role and location. Work-from-home eligibility varies by position but is called out as a valued option.
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Career-Linked Recognition & Rewards — Recognition programs such as R1 Stars are implemented to boost engagement and morale. Feedback suggests these programs help reduce turnover and provide acknowledgment beyond base pay.
R1 RCM Insights
What We Do
R1 is a leading provider of technology-driven solutions that transform the patient experience and financial performance of healthcare providers R1’s proven and scalable operating models seamlessly complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.
