DRG Denial & Appeals Specialist: Revenue Integrity

WVU Medicine; Oregon; Hybrid; USD 85,000 - 110,000; Full time

Job summary

SYSTEM West Virginia University Health System is seeking a DRG Clinical Denial Specialist to oversee denial management, review medical records for coding accuracy, and prepare clinical appeals. You will work with revenue cycle, coding, and clinical teams to ensure compliant documentation and maximize recoveries.

The role requires strong knowledge of regulatory guidelines, ongoing professional development, and the ability to communicate effectively with payers and auditors in a fast-paced

Qualifications

• Must have a relevant degree plus 3–5 years of hospital billing/revenue cycle experience.
• Certification/licensure in RN/LPN, RHIT/RHIA, CCDS/CDIP, CCS, CIC optional per job requirements.
• Experience with CMS guidelines and coding conventions is highly desirable.

Responsibilities

• Manage timely reviews of hospital billing audits and responses.
• Collaborate with CRC educators for content and trends.
• Complete clinical appeal writing for insurance denials.
• Ensure DRG accuracy and documentation relevance.
• Negotiates with external auditors to resolve disputed charges.

Skills

Healthcare revenue cycle knowledge

Clinical documentation improvement (CD

Education

Associate degree in healthcare administration, Nursing, Health Information Management, or related field

Bachelor's degree in healthcare administration, Nursing, Health Information Management, or related field

Tools

Epic

Excel

Solventum

Wellington

MSDRG/DRG groupers

Job description

SYSTEM West Virginia University Health System is seeking a DRG Clinical Denial Specialist to oversee denial management, review medical records for coding accuracy, and prepare clinical appeals. You will work with revenue cycle, coding, and clinical teams to ensure compliant documentation and maximize recoveries.

The role requires strong knowledge of regulatory guidelines, ongoing professional development, and the ability to communicate effectively with payers and auditors in a fast-paced