Coding Denials Auditor & Appeals Specialist

Baylor Scott & White Health; Nashville (TN); On-site; USD 75,000 - 105,000; Full time

Benefits offered by this job

Immediate health and welfare benefits

401(k) with 5% match

Tuition Reimbursement

PTO from Day 1

Job summary

Baylor Scott & White Health seeks a DRC Coding Auditor to partner with a multidisciplinary team to resolve coding denials for Hospital and Professional Billing. You will audit, appeal, and improve denial strategies while ensuring documentation supports billed services.

Role requires advanced knowledge of inpatient/outpatient coding and CMS regulations, plus collaboration with clinical validation RNs to reduce denials and improve revenue cycle performance.

Qualifications

• Education: HS diploma or GED; HIM/Healthcare degree preferred.
• 6+ years in coding, audits, denial management, revenue cycle.
• Certifications: CPC, CCS, CCS-P, RHIT, RHIA or equivalent.
• Strong knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG, MUE.
• Experience reviewing denials for HB and PB claims.
• Excellent written and verbal communication; persuasive appeal arguments.

Responsibilities

• Review and audit coding-related denials to determine resolution and appeal strategy.
• Investigate and appeal HB/PB denials, including MUE denials and DRG downgrades.
• Apply knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG assignment, NCCI, MUE, payer policies.
• Prepare and submit clear, compliant appeal documentation.
• Identify denial trends and perform root cause analysis.
• Communicate findings and trends to DRC leadership and stakeholders.
• Maintain audit-ready documentation and related systems.

Skills

Coding audits

Denial management

Root cause analysis

Communication skills

Epic

Payer portals

Education

HS diploma or GED

Associate's or Bachelor's in Health Information Management

Tools

Epic

Encoder software

Microsoft Office

Excel

Word

Payer portals

Job description

Baylor Scott & White Health seeks a DRC Coding Auditor to partner with a multidisciplinary team to resolve coding denials for Hospital and Professional Billing. You will audit, appeal, and improve denial strategies while ensuring documentation supports billed services.

Role requires advanced knowledge of inpatient/outpatient coding and CMS regulations, plus collaboration with clinical validation RNs to reduce denials and improve revenue cycle performance.