Appeals Specialist

**Req Number** 179272

Required: Background in Inpatient with 3-5 years' experience in Coding or Auditing.

Highly Preferred: Auditing experience with DRGs.

Job Description

Responds to commercial payers, managed care and third party review organizations in managing the appeals/denials process. Supports the review of denial trends and identifies coding issues and knowledge gaps.

Job Responsibility

+ Supports denial reviews and response processes; prioritizes and reviews cases denied by commercial payers.
+ Reports program performance and/or corrective action to management on regular basis.
+ Assists in monitoring inpatient denial types, volume and formulates responses to requesting agency; seeks additional resources (e.g. legal counsel) to resolve issues, as needed; develops case-specific written rationale to substantiate and communicate findings.
+ Addresses coding issues and knowledge gaps; functions as a organization res...

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