Appeals and Denials Specialist

Responsibilities: Review inpatient medical records to prepare evidence-based appeal letters for DRG downgrades and clinical validation denials. Collaborate with physicians and CDI professionals to ensure accurate clinical representation and high-quality documentation.

Requirements: Requires an Associate or Bachelor's degree in Nursing or equivalent clinical education, with at least three years of CDI or inpatient denial management experience. Proficiency in ICD-10 coding guidelines and experience with EHR systems are essential.

Key skills: Clinical Documentation Integrity, DRG Downgrade Appeals, Clinical Validation, ICD-10-CM/PCS Coding, Medical Record Review, Evidence-Based Appeal Writing, EHR Navigation, Reimbursement Optimization, HIPAA Compliance, Analytical Thinking, Written Communication, Time Management

Keywords: Clinical Documentation Integrity, CDI, DRG, ICD-10-CM, ICD-10-PCS, Clinical Validation, Medical Records, Revenue Cycle, HIPAA, CCDS, CDIP, RN, NP, PA, MD, EHR, Reimbursement, Appeal Letters, Healthcare Compliance