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Acute Coding Appeals Specialist
Ensemble Health Partners. Review and write appeals for inpatient Diagnosis Related Group (DRG) denials .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates advanced knowledge of medical coding and billing systems, including expertise in ICD10CM, ICD10PCS, HCPCS, and regulatory requirements. Proven ability to review and write appeals for inpatient DRG denials while providing organized customer service and training for coding companions.
Highest-signal resume keywords
Inpatient Facility Coding ExperienceICD10CM Coding ExpertiseActive Coding CertificationMedical Billing KnowledgeRegulatory Compliance Understanding
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical CodingBilling SystemsClinical Documentation ReviewCoding GuidelinesDRG Denials ManagementCoding RecommendationsRoot-Cause AnalysisProductivity StandardsCoding AppealsQuality Concerns Identification
Soft Skills
Inquisitive MindsetOpen to InnovationCustomer Service Orientation
Certifications & Qualifications
RHIARHITCCSCICCPCCOC
Industry Keywords
ICD10PCSHCPCSNCCICMSCMGRegulatory StandardsPayer-Specific GuidelinesGovernmental RulesHospital-Specific GuidelinesCoding/CDI Guidelines
About the role
Key responsibilities & impact- Review and write appeals for inpatient Diagnosis Related Group (DRG) denials
- Support assigned DRGs and address clinical documentation used to validate assigned codes
- Determine potential billing/coding issues and quality concerns
- Participate in client system education
- Review client accounts to ensure coding is supported by clinical documentation, coding/CDI guidelines, and regulatory standards
- Maintain documentation, spreadsheets, account records, and claim examples of root-cause issues
- Research governmental, payer-specific, hospital-specific, regulatory, and literature rules and guidelines
- Make coding and billing recommendations to clients
- Assist with education and training for client coding companions based on coding appeals outcomes
- Meet established productivity standards and coding certification requirements
- Attend in-house sessions for updated coding and regulatory information
- Provide organized, efficient customer service
Requirements
What you’ll need- Previous inpatient facility coding experience, including appeals, denials, and edits
- 5 years of previous experience in coding
- Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements
- Expertise in ICD10CM, ICD10PCS, HCPCS, NCCI, CMS, and CMG coding
- Active coding certification, such as RHIA, RHIT, CCS, CIC, CPC, or COC
- High School Diploma or GED
- Must be inquisitive and open to innovation, including AI
- Must reside in and be authorized to work within the United States
- Willingness and ability to travel to and work onsite at client, temporary, or corporate office locations as business needs require
Benefits
Comp & perks- Bonus Incentives
- Paid Certifications
- Tuition Reimbursement
- Comprehensive Benefits, including healthcare, time off, retirement, and well-being programs
- Career Advancement
- Professional development opportunities
- Quarterly and annual incentive programs
- Work-life flexibility
- Reasonable accommodations for qualified individuals with disabilities