Coding Audit & Appeals Specialist

TriHealth; Norwood (OH); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement plans

Tuition reimbursement

Job summary

TriHealth in Cincinnati/Norwood is seeking a Coding Audit & Appeals Specialist to protect revenue by resolving denials and crafting effective appeals. You will apply ICD-9/ICD-10, DRG, CPT, and CDI expertise to ensure accurate, compliant coding and hospital billing.

You’ll collaborate with billing teams and internal partners, stay current on coding guidelines, and contribute to a culture of accuracy, compliance, and service excellence within TriHealth.

Qualifications

• Associate's Degree in Coding RHIT (Required).
• 3–4 years experience in related field.
• Billing/Payer knowledge of hospital billing.
• Familiar with CDI, ICD-9/ICD-10, DRG.
• Knowledge of CPT coding guidelines.
• Medical terminology and physiology knowledge.
• CPC/CCS/CMC/CCA certifications required on hire.

Responsibilities

• Assist with denials follow-up and chart reviews for coding issues.
• Back up team members and support Payroll-related tasks when needed.
• Ensure compliance with coding rules from government and payers.
• Maintain standardized coding/billing procedures across departments.
• Stay current with coding revisions and provide denials resolution.
• Collaborate with billing teams to appeal denials and track outcomes.

Skills

ICD-9/ICD-10 knowledge

DRG understanding

CPT coding knowledge

Medical terminology

Physiology

Payer/billing review

Education

RHIT degree or equivalent

CPC Certification

CCS Certification

CMC Certification

CCA Certification

Job description

Join TriHealth as a Coding Audit & Appeals Specialist!

TriHealth offers Coding Audit & Appeals Specialists the opportunity to make a meaningful impact by protecting revenue, reducing financial loss, and ensuring accurate, compliant coding practices across the organization. In this role, you’ll apply your expertise in ICD‑9, ICD‑10, DRG, CPT, CDI, and hospital billing to resolve complex denials, collaborate with payers, and craft effective appeals that support maximum reimbursement. You’ll serve as a trusted resource to billing teams and internal partners, helping them navigate coding issues, interpret regulations, and maintain standardized, high‑quality coding and billing procedures.

As one of Cincinnati’s most respected healthcare employers, TriHealth provides a supportive, collaborative environment where your technical knowledge and problem‑solving skills are valued. You’ll work closely with multiple departments, stay current on evolving coding guidelines, and contribute to a culture committed to accuracy, compliance, and service excellence. TriHealth invests in its people - offering stability, professional growth, and the chance to build a rewarding career while advancing the organization’s mission of delivering exceptional care.

Location:

• TriHealth in Norwood at 4685 Forest Ave, Cincinnati, OH 45212

Work Schedule:

• Full-Time (80 hours biweekly)
• Day Shift
• No Weekend, Holiday or On Call Commitment

Benefits:

In addition to a comprehensive benefits package - including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement. Please view our benefits page https://careers.trihealth.com/what-we-offer/benefits

Job Requirements:

• Associate's Degree in Coding RHIT (Associates) (Required)
• 3 - 4 years experience in related field (Required)
• Billing/Payer knowledge of hospital billing
• Must be familiar and experienced with CDI. ICD-9, ICD-10, DRG
• CPT Coding guidelines
• Medical terminology
• Physiology
• Other Insurance\Certified Pension Consultant (CPC) Upon Hire Required
• Other CCS-Certified Coding Specialist Upon Hire Required
• Other CMC - Cardiac Medicine-Subspecialty Certification Upon Hire Required
• Other CCA - Certified Coding Associate Upon Hire Required

Job Overview:

Principal purpose is to expedite hospital coding denials to ensure maximum reimbursement and to reduce/eliminate financial loss to department customers. Contact payers regarding coding issues and using appeal letters to reduce fatal denials. Provides coding expertise to billing teams to assist in proper billing

Job Responsibilities:

• Assists with billing/coding questions from both internal and external customers which include, following up on denials, review of charts and coding issues.
• Backs up for team members within Payroll and all other special assignments from Payroll Director.
• Ensures understanding and compliance with coding protocols, rules and regulations from government agencies, insurance carriers, and other resources.
• Maintains a close working relationship with all departments and consolidates efforts to ensure appropriate and standardized coding/billing procedures are followed.
• Maintains knowledge of current coding revisions.
• Resolves coding issues that arise within the patient accounting departments and provides coding support.
• Works directly with the billing teams to ensure denials for coding are appealed and followed up on appropriately, and in a timely manner.

Working Conditions:

Climbing - Rarely

Concentrating - Consistently

Continuous Learning - Consistently

Hearing: Conversation - Frequently

Interpersonal Communication - Frequently

Kneeling - Rarely

Lifting <10 Lbs. - Rarely

Lifting 50+ Lbs. - Rarely

Lifting <50 Lbs. - Rarely

Pulling - Rarely

Pushing - Rarely

Reaching - Rarely

Reading - Consistently

Sitting - Consistently

Standing - Rarely

Stooping - Rarely

Thinking/Reasoning - Consistently

Use of Hands - Frequently

Color Vision - Consistently

Walking - Occasionally

TriHealth SERVE Standards and ALWAYS Behaviors

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS...

• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel: ALWAYS...

• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
• Offer patients and guests priority when waiting (lines, elevators)
• Work on improving quality, safety, and service

Respect: ALWAYS...

• Respect cultural and spiritual differences and honor individual preferences.
• Respect everyone's opinion and contribution, regardless of title/role.
• Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS...

• Value the time of others by striving to be on time, prepared and actively participating.
• Pick up trash, ensuring the physical environment is clean and safe.
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS...

• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members and the community