Inpatient Coding Appeals Specialist

INPATIENT CODING APPEALS SPECIALIST

Key Responsibilities:

• Review inpatient medical records to validate principal diagnosis, secondary diagnoses (CC/MCC), procedures, and DRG assignments.
• Analyze payer denials involving:
• DRG downgrades
• Removal of CC/MCC
• Clinical validation denials
• Coding validation disputes
• Prepare clear, concise, and compliant DRG appeal letters supported by:
• ICD-10-CM/PCS Official Guidelines
• UHDDS reporting requirements
• eCMS 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 quality audits, peer reviews, and continuous process improvement initiatives
• Maintain strict compliance with HIPAA and data privacy regulations.

Required Qualifications:

• Inpatient Coding Experience (required)
• Strong working knowledge of:
• ICD-10-CM and ICD-10-PCS
• MS-DRG and APR-DRG systems
• CC/MCC logic and DRG impact
• Demonstrated experience handling DRG appeals or inpatient coding denials
• Ability to interpret complex medical documentation and translate findings into defensible appeal narratives.
• Excellent written communication skills with the ability to cite official coding and clinical references.
• High attention to detail, critical thinking, and strong analytical skills.
• Ability to work independently while meeting productivity and quality benchmarks