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Full-Time Opportunity: This is a permanent, full-time position with a competitive package and real career growth potential.
Job Description
Key Responsibilities
- Review inpatient medical records to validate principal diagnosis, secondary diagnoses (CC/MCC), procedures, and DRG assignment.
- Analyze payer denials involving DRG downgrades, removal of CC/MCC, clinical validation denials, and coding validation disputes.
- Prepare clear, concise, and compliant DRG appeal letters supported by ICD‑10‑CM/PCS official guidelines, UHDDS reporting requirements, CMS rules, and industry references (e.g., AHA Coding Clinic, AHIMA guidance).
- Defend secondary diagnoses and MCC/CC assignments based on provider documentation and coding standards.
- Collaborate with clinical reviewers, CDI teams, and revenue cycle leadership to resolve complex cases.
- Ensure timely filing of appeals in accordance with payer and client deadlines.
- Accurately document appeal outcomes and maintain tracking logs for productivity, quality, and turnaround time.
- Participate in qualit...