Clinical Appeals Review RN, DRG

Clinical Appeals Review RN, DRG

Remote | Full-Time | $32-45 per hour

Work Remotely. Grow Professionally. Feel Valued.

For more than 30 years, Managed Resources, Inc. has partnered with healthcare organizations nationwide to improve performance, strengthen revenue cycle operations, support compliance, and help providers focus on delivering quality patient care.

We’re proud of the work we do, but we’re equally proud of the workplace we’ve built.

At Managed Resources, you’ll find the stability and reputation of an established healthcare consulting firm combined with the accessibility, collaboration, and growth opportunities of a smaller organization. Here, your contributions are visible, your ideas are welcomed, and your work makes a meaningful impact.

Compensation

Salary Range: $32 - $45 per hour

Actual compensation will be determined based on factors including experience, qualifications, specialized skills, geographic location, and internal equity considerations.

Quick Facts

• Remote
• Full-Time
• Competitive Compensation
• Phone & Internet Stipend
• Medical, Dental, and Vision Benefits (Full-Time Employees)
• 401(k) Retirement Plan with Company Match
• Paid Time Off, Seven Company Holidays, and Two Floating Holidays (Full-Time Employees)
• Professional Development Opportunities
• Employee Recognition Programs

Why Join Managed Resources?

Your Voice Matters

At Managed Resources, employee feedback isn’t collected and forgotten; it helps drive meaningful change.

Employee feedback has contributed to enhancements in employee recognition programs, professional development opportunities, communication initiatives, employee experience improvements, and technology investments. We believe the people closest to the work often have the best ideas.

Feeling Valued Matters

We believe great work deserves recognition.

Throughout the year, we celebrate employee contributions through appreciation initiatives, recognition programs, milestone celebrations, and professional observances such as Nurses Week and Coding Week. We intentionally create opportunities for employees to feel seen, valued, and appreciated.

A Remote Team That Stays Connected

Remote work shouldn’t mean feeling disconnected.

We foster connection through virtual team events, company celebrations, employee appreciation activities, holiday gatherings, and opportunities for collaboration across teams. Our employees enjoy the flexibility of remote work while remaining part of an engaged and supportive culture.

Opportunities to Learn and Grow

Whether you’re looking to deepen your expertise, expand your skill set, or take the next step in your career, Managed Resources supports continuous learning and professional growth.

Our leaders are accessible, collaborative, and invested in helping employees succeed.

The Best of Both Worlds

As an established organization with more than three decades of success, we offer stability, industry expertise, and long-standing client relationships.

As a smaller organization, employees have the opportunity to build meaningful relationships, gain visibility with leadership, contribute ideas, influence change, and make a measurable impact on the organization.

Your work matters here.

About the Opportunity

The Clinical Appeals Review Nurse reviews and analyzes denied/downgraded MS-DRG and APR-DRG and APC accounts received from all types of payers (e.g., Medicare, Commercial, and Third Party). Utilizing clinical and coding expertise, the Nurse will render determination on whether the denied/downgraded account is appealable based on the standards of each client.

Why This Role Matters

What You’ll Gain

• Flexibility of a remote work environment
• Visibility and access to leadership
• Opportunity to contribute ideas and influence change
• Professional development and career growth opportunities
• Meaningful work supporting healthcare organizations nationwide
• A collaborative culture that values employee success, recognition, and work-life balance

What You’ll Do

• Conduct secondary quality reviews of clinical appeal letters to ensure accuracy, clinical soundness, and compliance with coding, payer, and regulatory requirements prior to submission.
• Perform efficient analysis of denied claims, pinpointing reason for denial and potential for success of appeal including correct allocation of diagnostic and procedural codes under ICD-10 Official Coding Guidelines and ICD-10 Procedural Coding Guidelines, 3M APR-DRG Classification System, CPT, HCPCS, Revenue Code, and All associated authorities such as CMS regulations, statutes, and associated authorities such as AHA Coding Clinics and CPT Assistant
• Write clear and concise grammatically correct appeals letter in MRI format and to MRI quality standards
• Be aware of the level of appeal, level of future appeals available and write according to the level of appeal
• Utilize current applicable clinical, legal, and coding standards
• Understand and strictly comply with time deadlines; write appeals in an efficient and timely manner
• Provide a reasoned root cause analysis and summary review for all clients within MRI standard
• At all time observe all HIPAA standards
• Obtain and maintain client computer accesses
• Participate in preparation of clear and concise audit report, as needed
• Stay current in clinical, coding, and appeal writing areas and comply with MRI quality recommendations to maintain efficient and effective processes
• Identify coding and clinical documentation issues and provide proactive recommendations through manager to clients
• Identify problem account and seek review or return to client through manager, as appropriate
• Clearly and concisely update patient account record to identify actions taken on account
• Responsible to work through manager to liase with third party payer and agencies regarding appeals to ensure optimal reimbursement and resolve billing issues, contract misrepresentations and payment discrepancies

What You’ll Bring

• Registered Nurse (BSN preferred)

• CCS, CPC, CCDS, or RHIT Certification is required
• Graduate of an accredited College or University, BSN is preferred
• 5+ years of clinical experience in Hospital inpatient and outpatient departments
• 2+ years of clinical appeals/denials writing experience
• Experience reviewing and analyzing denied/downgraded MS-DRG and APR-DRG and APC medical records and accounts received from payers (e.g., Medicare, Commercial, and Third Party)
• Experience in a variety of Electronic Medical Records (EMR) Systems, i.e. (3M, Nuance, Epic, etc)

Benefits & Perks

Full-Time Employees

• Medical, Dental, and Vision Insurance
• Phone and Internet Stipend
• Company-Paid Life Insurance
• 401(k) Retirement Plan with Company Match
• Paid Time Off
• Seven Company-Observed Holidays
• Two Floating Holidays for Personal Observance
• Professional Development Opportunities
• Employee Recognition Programs
• Remote Work Environment

Ready to Join Us?

If you’re looking for a company where your expertise is respected, your contributions are recognized, and your work has a meaningful impact, we’d love to hear from you.

Join a team that combines the stability of an established healthcare consulting organization with the culture, connection, and growth opportunities of a smaller company.

Apply today and build your career with Managed Resources.

Managed Resources, Inc. is an Equal Opportunity Employer and is committed to creating an inclusive workplace where all employees can thrive.