Acute Coding Appeals Specialist

Ensemble Health Partners; Columbus (OH); Remote; USD 41,000 - 44,000; Full time

Benefits offered by this job

Bonus Incentives

Paid Certifications

Tuition Reimbursement

Comprehensive Benefits

Career Advancement

Job summary

Ensemble Health Partners is seeking a Remote Coding Appeals Specialist to join our team and support hospital and health system clients nationwide. You will apply ICD10CM/PCS, HCPCS, NCCI, CMS and CMG guidelines to substantiate coding decisions and draft DRG-related appeals with precision.

Responsibilities include maintaining meticulous documentation, educating clients on coding requirements, and collaborating to improve patient care outcomes while meeting productivity and certification

Qualifications

• Previous inpatient facility coding experience, working appeals, denials and edits.
• 5 years previous experience in coding, required.
• Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements.
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Responsibilities

• Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns.
• Participates in client system education to gain the knowledge necessary to appeal client accounts in ensuring that the coding is supported by the patient’s clinical documentation, coding/cdi guidelines and other regulatory standards/guidelines as appropriate.
• Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues.
• Performs searches of governmental, payor‑specific, hospital‑specific, regulatory body, and literature rules, regulations, guidelines to identify and coding and billing requirements to make recommendations to client.
• Assist in education and training for client coding companion as it relates to the outcomes of the coding appeals.
• Meet established productivity standards for coding appeals & coding certification requirement.
• Attends in‑house sessions to receive updated coding information and changes in coding and/or regulations.
• Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude.

Skills

inpatient coding experience

Education

High School Diploma or GED

Tools

Medical coding systems

Job description

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

O.N.E Purpose: Customer Obsession

Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

Embracing New Ideas

Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

Striving for Excellence

Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity

CAREER OPPORTUNITY OFFERING:

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement

This position pays between $29.70 - $31.80 based on experience.

The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities. Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns. Under indirect supervision, the Coding Appeals Specialist is responsible for reviewing and writing appeals for inpatient Diagnosis Related Group, (DRG) denials in order to support the assigned DRG and to address the clinical documentation utilized in the decision‑making process to support the validity of the assigned codes.

Job Responsibilities

• Draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise and industry knowledge to substantiate coding principles to determine potential billing/coding issues, and quality concerns.
• Participates in client system education to gain the knowledge necessary to appeal client accounts in ensuring that the coding is supported by the patient’s clinical documentation, coding/cdi guidelines and other regulatory standards/guidelines as appropriate.
• Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues.
• Performs searches of governmental, payor‑specific, hospital‑specific, regulatory body, and literature rules, regulations, guidelines to identify and coding and billing requirements to make recommendations to client.
• Assist in education and training for client coding companion as it relates to the outcomes of the coding appeals.
• Meet established productivity standards for coding appeals & coding certification requirement.
• Attends in‑house sessions to receive updated coding information and changes in coding and/or regulations.
• Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude.

Required Experience

Previous inpatient facility coding experience, working appeals, denials and edits.

5 years previous experience in coding, required.

Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements.

Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Minimum Education

High School Diploma or GED

Required Certification

Active Coding Certification (i.e. RHIA, RHIT, CCS, CIC, CPC, COC, etc.)

Join an award‑winning company

• Five‑time winner of “Best in KLAS” 2020‑2022, 2024‑2025
• Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021‑1222
• Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019‑2024
• Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
• Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022‑2023
• Energ​age Top Workplaces USA 2022‑2024
• Fortune Media Best Workplaces in Healthcare 2024
• Monster Top Workplace for Remote Work 2024
• Great Place to Work certified 2023‑2024

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive.

We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well‑being programs.

Our Culture

Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.

Growth

We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.

Recognition

We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.

Due to business, operational, payroll, and regulatory requirements, this position is limited to individuals who reside and are authorized to work within the United States. Applications generated from outside the United States will not be considered. Individuals may reapply when located within the United States.

Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law.

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job‑related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.