Acute Coding Appeals Specialist
Core
Review and write appeals for inpatient Diagnosis Related Group (DRG) denials to support assigned codes and address clinical documentation validity.
Role type
Acute Coding Appeals Specialist
Builds
Substantiated coding principles and billing/coding issue resolutions for health systems and physician groups
Domain
Healthcare revenue cycle management / Medical coding
Required skills
ICD10CM, ICD10PCS, HCPCS, NCCI, CMS, CMG coding expertise, inpatient facility coding, appeals and denials management, regulatory standards knowledge, clinical documentation review
Preferred skills
AI process exploration, client system education, root cause analysis, productivity standards adherence
Technologies
Medical coding and billing systems
Responsibilities
Review and write appeals for inpatient DRG denials; Participate in client system education to ensure coding is supported by clinical documentation; Maintain documentation and spreadsheets of root cause issues; Assist in education and training for client coding companions; Meet established productivity standards for coding appeals; Attend in-house sessions for updated coding information
Seniority
Mid-level, hands-on IC