Strategic Inpatient Denials & Appeals Specialist

HCM Nexus; Pasig; On-site; PHP 480,000 - 560,000; Full time

Job summary

Nexus Recruitment Group is seeking an In-Patient Coding Denials Specialist in the Philippines. This role focuses on analyzing and resolving inpatient coding denials to ensure timely reimbursement and minimize revenue loss.

The ideal candidate has 2–3 years of inpatient coding experience, familiarity with ICD-10-CM/PCS, DRG methodologies, and payer audit protocols. Certification (CCS or CIC) is preferred.

Qualifications

• Requires 2–3 years of inpatient coding experience with denial management or appeals.
• Solid understanding of ICD-10-CM/PCS, DRG methodologies, and payer audit protocols.
• Familiarity with HIPAA and data privacy standards.
• Certification preferred: CCS, CIC, or equivalent.

Responsibilities

• Review denied inpatient claims to identify root causes in coding, DRG, or documentation.
• Prepare and submit coding-related appeals with supporting references.
• Coordinate with coders, QA, and clinical documentation teams to resolve discrepancies.
• Track denial trends and provide actionable feedback to reduce future denials.
• Stay updated on payer denial policies and audit risk areas.
• Maintain documentation of appeal activities and timelines.
• Help develop denial prevention strategies and internal resources.

Skills

Attention to detail

Analytical thinking

Written communication

Education

Associate or Bachelor degree in Health Information Management, Nursing, or related field

Tools

EHR systems

Job description

About the job In-Patient Coding Denials Specialist

Job Summary:

We are looking for a detail-oriented Inpatient Coding Denials Specialist to analyze and resolve coding-related denials, with a focus on ensuring timely reimbursement and reducing revenue loss. This role requires a solid understanding of inpatient coding guidelines, payer denial patterns, and appeals processes. The ideal candidate is highly analytical, knowledgeable in denial management workflows, and capable of collaborating across teams to improve claim outcomes.

Key Responsibilities:

• Review and analyze denied inpatient claims to identify root causes related to coding, DRG assignment, or documentation.
• Prepare and submit coding-related appeals with supporting clinical and coding references.
• Coordinate with coders, QA, and clinical documentation teams to resolve discrepancies or documentation gaps contributing to denials.
• Track denial trends and provide actionable feedback to reduce future occurrences.
• Stay updated on payer-specific denial policies, coding updates, and audit risk areas.
• Maintain accurate documentation of appeal activities and resolution timelines using internal systems.
• Assist in developing and refining denial prevention strategies, job aids, and internal resources.

Qualifications:

• Associates or Bachelors degree in Health Information Management, Nursing, or a related field preferred.
• Certification required: CCS (Certified Coding Specialist), CIC (Certified Inpatient Coder), or equivalent.
• Minimum of 2-3 years of inpatient coding experience, with at least 1 year in denial management or appeals.
• Strong understanding of ICD-10-CM, ICD-10-PCS, MS-DRG/APR-DRG methodologies, and payer audit protocols.
• Familiarity with EHR systems and claims management tools.
• Working knowledge of HIPAA and data privacy standards.

Preferred Skills:

• Experience resolving denials across multiple health systems or provider documentation formats.
• Strong written communication skills, particularly in drafting appeals and summarizing clinical rationale.
• Ability to work independently and manage multiple deadlines in a fast-paced environment.
• Familiarity with payer portals, denial codes, and claim adjudication workflows is a plus.