Acute Coding Appeals Specialist

About the role

CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between $29.70 - $31.80 based on experience The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns. Under indirect supervision, the Coding Appeals Specialist is responsible for reviewing and writing appeals for inpatient Diagnosis Related Group, (DRG) denials in order to support the assigned DRG and to address the clinical documentation utilized in the decision-making process to support the validity of the assigned codes. Job Responsibilities: The appeals professional integrates medical coding principles and objectivity in the performance of coding appeals/denials activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns Participates in client system education to gain the knowledge necessary to appeal client accounts in ensuring that the coding is supported by the patient's clinical documentation, coding/cdi guidelines and other regulatory standards/guidelines as appropriate Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules, regulations, guidelines to identify and coding and billing requirements to make recommendations to client Assist in education and training for client coding companion as it relates to the outcomes of the coding appeals Meet established productivity standards for coding appeals & coding certification requirement Attends in-house sessions to receive updated coding information and changes in coding and/or regulations Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude Required Experience: Previous inpatient facility coding experience, working appeals, denials and edits 5 years previous experience in coding, required Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences. This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require. Minimum Education: High School Diploma or GED Required Certification: Active Coding Certification (i.e. RHIA, RHIT, CCS, CIC, CPC, COC, etc.) #LI-HB1 #LI-REMOTE Join an award-winning company Five-time winner of "Best in KLAS" 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023 Energage Top Workplaces USA 2022-2024 Fortune Media Best Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified 2023-2024 Innovation Work-Life Flexibility Leadership Purpose + Values Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include: Associate Benefits