DRG Denial Appeals Specialist (RN/CDI)

DaMar Staffing; Torrington (CT); On-site; USD 85,000 - 110,000; Full time

Job summary

Hartford HealthCare is seeking a Level 2 Denial Specialist Appeal Writer to review DRG downgrades and prepare detailed, evidence-based appeal letters defending assigned DRGs and optimizing reimbursement. The role requires interpreting medical records, applying coding guidelines, and understanding payer contracts while collaborating with CDI teams and physicians.

The candidate will educate leaders and teams on best practices, identify denial trends, and help reduce future denials while ensuring

Qualifications

• Bachelor of Science in Nursing required.
• Four years of inpatient or CDI experience preferred.
• CT RN license and CCDS/CDIP certifications required or preferred.

Responsibilities

• Educate CDI and provider teams on DRG validation and documentation best practices.
• Review DRG downgrades and assess appeal potential.
• Analyze medical records and coding to support billed DRG using ICD-10-CM/PCS guidelines.
• Prepare persuasive appeal letters with patient summaries and citations.
• Maintain appeal records and track deadlines for submissions.
• Lead trend analysis to identify denial patterns and propose improvements.
• Meet KPIs for turnaround times, appeal success, and denial reduction.

Skills

ICD-10-CM/PCS coding knowledge

Analytical thinking

Attention to detail

Written communication

Cross-functional teamwork

Problem solving

Deadline management

Education

Bachelor of Science in Nursing

Master’s degree or equivalent

Active RN license in Connecticut

CCDS

CDIP

Job description

Hartford HealthCare is seeking a Level 2 Denial Specialist Appeal Writer to review DRG downgrades and prepare detailed, evidence-based appeal letters defending assigned DRGs and optimizing reimbursement. The role requires interpreting medical records, applying coding guidelines, and understanding payer contracts while collaborating with CDI teams and physicians.

The candidate will educate leaders and teams on best practices, identify denial trends, and help reduce future denials while ensuring