DRG Denials & Appeals Specialist

DaMar Staffing; Manchester (CT); On-site; USD 90,000 - 120,000; Full time

Job summary

Hartford HealthCare is seeking a Level 2 Denial Specialist Appeal Writer to review DRG downgrades, analyze medical records, and craft evidence-based appeal letters to optimize reimbursement. You will educate CDI teams and providers on best practices to minimize future denials.

The role requires nursing education, strong communication, and a track record in DRG denial management with a focus on accurate documentation and payer guidelines adherence.

Qualifications

• Bachelor of Science in Nursing required.
• CCDS/CDIP certifications preferred.
• Minimum four years in inpatient or clinical documentation with DRG denial experience.

Responsibilities

• Provide ongoing education on DRG validation and denial prevention.
• Review DRG downgrades and assess appeal potential.
• Analyze medical records and coding to support billed DRG using guidelines.
• Prepare persuasive appeal letters with citations and patient summary.
• Maintain appeal records and meet payer submission deadlines.
• Lead trend analyses to identify denial patterns and drive improvements.
• Achieve KPIs for turnaround times and denial reduction.

Skills

DRG denial management

Appeals writing

Medical coding knowledge

ICD-10-CM/PCS

Education delivery

Payer contract requirements

Regulatory knowledge

Education

Bachelor of Science in Nursing

Master’s degree or equivalent

Tools

Tracking systems

Payer guidelines databases

Job description

Hartford HealthCare is seeking a Level 2 Denial Specialist Appeal Writer to review DRG downgrades, analyze medical records, and craft evidence-based appeal letters to optimize reimbursement. You will educate CDI teams and providers on best practices to minimize future denials.

The role requires nursing education, strong communication, and a track record in DRG denial management with a focus on accurate documentation and payer guidelines adherence.