Use your clinical expertise to support hospitals and healthcare systems by overturning incorrect claim denials and ensuring accurate reimbursement.
About Knowtion Health
Knowtion Health helps hospitals and healthcare organizations resolve complex claims through expert clinical review and strategic appeals. As a leader in this fast-growing industry, the company invests heavily in innovation and responds quickly to changing payer policies. Their culture is competitive, collaborative, and focused on results that make a lasting impact.
Knowtion Health participates in E-Verify.
Schedule
- Full-time, remote
- Must reside in one of the approved states: AL, AR, AZ, CO, FL, GA, ID, IL, IN, KS, KY, MA, MD, ME, MI, MN, MO, MS, NC, NM, NV, OH, OK, PA, SC, TN, TX, VA, VT, WI, WV
- Requires a dedicated, distraction-free home workspace
What You’ll Do
- Review medical records to verify clinical indicators and coding accuracy for multiple audit types
- Prepare detailed appeal letters to overturn Medicare, Medicaid, and commercial payer denials
- Manage account inventory and follow-up timelines
- Review InterQual/Milliman criteria, coding guidelines, and payer policies to support appeals
- Identify root causes, trends, and documentation issues to report to leadership and clients
- Collaborate with peers on clinical writing and audit strategy
- Provide feedback and training insights for clinical and non-clinical staff
What You Need
- Active and unrestricted RN license
- Minimum 2 years in an acute care hospital
- 5+ years of medical record audit or coding experience preferred
- Experience with InterQual and Milliman criteria preferred
- Familiarity with CMS LCD/NCD criteria
- Knowledge of DRGs, ICD-10, CPT, and HCPCS coding
- Strong understanding of payer reimbursement guidelines
- Ability to meet productivity standards and manage complex clinical reviews
Benefits
- Medical, dental, and vision
- Life insurance
- Short-term and long-term disability
- Bonus opportunities
- Paid holidays
- 401(k)
- Generous PTO policy
This role is ideal for clinically experienced RNs who enjoy detailed review work, independent decision-making, and advocating for correct reimbursement.
Happy Hunting,
~Two Chicks…