Use your clinical expertise and coding knowledge to audit denied claims, write strong appeals, and help healthcare organizations recover lost revenue—all from a remote setting. This role is ideal for experienced RNs with deep clinical documentation and inpatient coding understanding.
About Conifer Health Solutions
Conifer Health Solutions partners with hospitals, health systems, and physician groups across more than 135 regions nationwide. With over 30 years of industry experience, Conifer strengthens financial performance, supports clinical operations, and improves the overall patient experience. The company is part of the Tenet and Catholic Health Initiatives family.
Schedule
- Fully remote position
- Requires independent work with minimal supervision
- May travel up to 10% to client sites or company locations
- Involves reviewing records, drafting appeals, and maintaining denial tracking tools
What You’ll Do
- Write persuasive appeal letters using clinical documentation, coding guidelines, evidence-based medical criteria, and physician advisor input
- Review denied claims for DRG validation, downgrades, and medical necessity
- Document findings in ACE and generate reports for leadership
- Review reimbursement methodologies including Managed Care rates, DRGs, outliers, per diems, and stop-loss calculations
- Collaborate with Physician Advisors and CRC leadership to resolve documentation concerns
- Monitor clinical denial trends and escalate issues when needed
- Maintain up-to-date expertise in clinical best practices, inpatient coding guidelines, utilization management, and regulatory standards
What You Need
- RN license in state of practice (required)
- Completion of a BSN program or ability to complete BSN within five years
- 3–5 years of clinical RN experience
- 3–5 years of Clinical Documentation Integrity experience
- Expertise with Interqual and/or MCG criteria
- Strong knowledge of CMS regulations, inpatient coding guidelines, and reimbursement methodologies
- Ability to research complex clinical and regulatory issues
- Moderate proficiency in Microsoft Excel, PowerPoint, and Office
- Excellent communication, writing, critical thinking, and analytical skills
Certifications (Required):
- RN, plus one of the following: CCDS, CCS, CCA, CIC, CPC, CPMA, or related documentation/coding credential
Preferred:
- BSN
- Experience preparing clinical appeals for DRG-related denials
- Knowledge of AHA Coding Clinics, AAMAS guidelines, CMS billing requirements, state-funded regulations, CPT/HCPCS, and ICD-10
Benefits
- Salary range: $56,784 – $85,176 annually (based on experience, location, and qualifications)
- Medical, dental, vision, disability, life, and business travel insurance
- PTO and sick leave (minimum 12 days per year)
- 10 paid holidays annually
- 401(k) with up to 6% employer match
- FSA, HSA, and dependent care accounts
- Employee Assistance Program and employee discount offerings
- Optional benefits including pet insurance, legal, accident, critical illness, long-term care, and more
A strong remote opportunity for RNs seeking to leverage their clinical experience in a coding, auditing, and appeals-focused role.
Advance your career while making real impact behind the scenes.
Happy Hunting,
~Two Chicks…