Advanced Coding Auditor: Denials & Appeals Specialist

Internationalinsuranceprofessionals; Austin, Northern (TX, KY); Hybrid; USD 70,000 - 110,000; Full time

Job summary

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with clinicians and revenue cycle teams. You will review complex coding denials, apply ICD-10-CM/PCS, CPT, DRG guidelines, and develop persuasive appeals to improve denials and reimbursement.

You will work with Clinical Validation RNs to ensure documentation supports billed services, identify trends, and help drive process improvements across HB and PB claims in a high-volume setting.

Qualifications

• Advanced knowledge of inpatient and outpatient coding principles.
• Experience in coding audits and denial management.
• Knowledge of CMS regulations and payer policies.

Responsibilities

• Review and audit coding-related denials to determine resolution.
• Investigate and appeal HB/PB denials including MUEs and DRG downgrades.
• Prepare and submit concise appeal documentation with supporting evidence.
• Conduct root cause analysis to identify denial trends and opportunities for improvement.

Skills

Epic proficiency

Encoder software

Payer portals

Microsoft Excel

Education

Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or related field

Tools

Epic

Encoder software

Payer portals

Job description

Baylor Scott & White Health is seeking a DRC Coding Auditor to partner with clinicians and revenue cycle teams. You will review complex coding denials, apply ICD-10-CM/PCS, CPT, DRG guidelines, and develop persuasive appeals to improve denials and reimbursement.

You will work with Clinical Validation RNs to ensure documentation supports billed services, identify trends, and help drive process improvements across HB and PB claims in a high-volume setting.