IP Coding Appeals Specialist

Health Business Solutions LLC; Pasig; On-site; PHP 334,800 - 558,000; Full time

Job summary

Health Business Solutions LLC is looking for an IP Coding Appeals Specialist to review inpatient coding denials and prepare appeals. This role plays a crucial part in enhancing reimbursement accuracy and collaborating with coding teams to support claim overturning.

The ideal candidate should have a bachelor's degree in a related field and extensive knowledge of coding systems like ICD-10-CM. Strong analytical skills and experience in handling payer denials are essential for success in this position.

Qualifications

• Minimum 2–4 years of inpatient coding and/or denial appeals experience.
• Strong knowledge of ICD-10-CM and ICD-10-PCS coding systems.
• Familiarity with CMS guidelines and commercial payer policies.

Responsibilities

• Review and analyze inpatient coding denials from payers.
• Prepare and submit detailed, evidence-based appeal letters.
• Collaborate with CDI teams to identify documentation gaps.

Skills

Strong analytical and critical thinking skills

Excellent written communication

Attention to detail and accuracy

Ability to interpret clinical documentation and payer policies

Proficiency in EHR systems and coding/abstracting tools

Education

Bachelor’s degree in Health Information Management, Nursing, or related field

Job description

Job Summary

The IP Coding Appeals Specialist is responsible for reviewing inpatient (IP) coding denials, preparing and submitting appeals, and ensuring accurate clinical documentation supports appropriate reimbursement. This role works closely with coding, CDI, and payer guidelines to overturn denied claims and optimize revenue recovery.

Key Responsibilities

• Review and analyze inpatient coding denials from payers (e.g., DRG downgrades, medical necessity denials).
• Interpret medical records to validate accurate ICD-10-CM/PCS coding and DRG assignment.
• Prepare and submit detailed, evidence-based appeal letters within payer timelines.
• Collaborate with Clinical Documentation Improvement (CDI) teams and coders to identify documentation gaps.
• Ensure compliance with payer-specific guidelines, CMS regulations, and coding standards.
• Track appeal outcomes and maintain documentation for reporting and audit purposes.
• Identify denial trends and provide recommendations to reduce future denials.
• Communicate with insurance payers when additional clarification or follow-up is required.
• Maintain productivity and quality standards as defined by the organization.

Qualifications

• Bachelor’s degree in Health Information Management, Nursing, or related field (preferred).
• Minimum 2–4 years of inpatient coding and/or denial appeals experience.
• Strong knowledge of ICD-10-CM and ICD-10-PCS coding systems.
• Strong knowledge of MS-DRG classification and reimbursement methodologies.
• Strong knowledge of medical terminology, anatomy, and physiology.
• Experience handling payer denials and writing appeals (clinical and coding-based).
• Familiarity with CMS guidelines and commercial payer policies.

Certifications

• CCS (Certified Coding Specialist).
• CPC (Certified Professional Coder) with inpatient experience.
• RHIT or RHIA.

Skills & Competencies

• Strong analytical and critical thinking skills.
• Excellent written communication (for appeal letters).
• Attention to detail and accuracy.
• Ability to interpret clinical documentation and payer policies.
• Time management and ability to meet deadlines.
• Proficiency in EHR systems and coding/abstracting tools.