DRG Denial & Appeals Specialist

WVU Medicine; Charleston (WV); In loco; USD 85.000 - 120.000; Tempo pieno

Descrizione del lavoro

WVU Medicine is seeking a DRG Clinical Denial Specialist to manage denial analysis and appeals in a hospital setting. You will review medical records for clinical relevance, validate DRG accuracy, and prepare comprehensive clinical appeals to support billing integrity.

The role requires strong knowledge of CMS guidelines, coding rules, and revenue cycle processes. You will collaborate with clinical, coding, and payer teams to improve documentation quality and reduce revenue leakage.

Competenze

• Associate or Bachelor’s in healthcare admin, nursing, HIM or related field.
• 5 years hospital billing, acute care, CDI, inpatient coding or revenue cycle with associate degree.
• 3 years with bachelor’s degree in the same fields.

Mansioni

• Manage timely review of enterprise hospital billing audits and responses.
• Prepare clinical appeals and negotiate with external auditors.
• Ensure DRG accuracy and coding compliance across documentation and billing.

Conoscenze

Hospital billing

Inpatient coding

Denials management

CMS guidelines

Negotiation

Formazione

Associate or Bachelor's in Healthcare Admin/Nursing/HIM

Strumenti

Epic

Excel

Solventum

Wellington

DRG Grouper

Descrizione del lavoro

WVU Medicine is seeking a DRG Clinical Denial Specialist to manage denial analysis and appeals in a hospital setting. You will review medical records for clinical relevance, validate DRG accuracy, and prepare comprehensive clinical appeals to support billing integrity.

The role requires strong knowledge of CMS guidelines, coding rules, and revenue cycle processes. You will collaborate with clinical, coding, and payer teams to improve documentation quality and reduce revenue leakage.