Description
Position Summary
We are seeking an experienced Inpatient Hospital Coder – Denial Appeals Specialist to review, analyze, and write compelling appeals for coding and DRG-related denials. This position requires a strong understanding of inpatient coding guidelines, MS-DRG assignment, clinical documentation, payer policies, and reimbursement principles.
The ideal candidate will have mid-level inpatient coding experience and the ability to translate complex coding and clinical information into clear, concise, and well-supported appeal arguments. The primary responsibility of this role is to develop accurate, evidence-based denial appeals that support appropriate reimbursement.
Key Responsibilities
Review inpatient coding and DRG denial cases to identify the reason for denial and determine the appropriate appeal strategy.
Analyze medical records, coding, clinical documentation, and payer denial rationale.
Write detailed, persuasive appeals addressing coding, sequencing, diagnosis/procedure assignment, and DRG-related denials.
Apply ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting and other applicable coding standards.
Evaluate MS-DRG assignments and identify discrepancies between the documented clinical circumstances and the payer's determination.
Research and reference applicable coding guidelines, CMS regulations, payer policies, and other authoritative sources to support appeals.
Clearly explain the clinical and coding rationale supporting the original code or DRG assignment.
Identify opportunities to strengthen appeals through additional documentation, coding guidance, or regulatory support.
Collaborate with clinical documentation specialists, coding leadership, utilization review, and other revenue cycle professionals as needed.
Maintain accurate documentation of appeal activity, outcomes, and supporting rationale.
Monitor denial trends and identify recurring coding or DRG issues that may require education or process improvement.
Meet established productivity, quality, accuracy, and turnaround-time standards.
Maintain confidentiality and comply with HIPAA and organizational policies.
Requirements
2–5 years of inpatient hospital coding experience or equivalent experience.
Strong knowledge of ICD-10-CM, ICD-10-PCS, and MS-DRG methodology.
Experience reviewing and interpreting inpatient medical records.
Demonstrated experience with coding and/or DRG denial appeals.
Strong understanding of inpatient coding guidelines and regulatory requirements.
Excellent written communication skills with the ability to develop clear, logical, and persuasive appeal arguments.
Strong analytical and critical-thinking skills.
Ability to independently research coding and reimbursement issues.
High level of attention to detail and accuracy.
Ability to manage multiple appeals and meet established deadlines.
