Inpatient Appeals Specialist

Care New England; Warwick (RI); On-site; USD 65,000 - 90,000; Full time

Job summary

Care New England is seeking an Inpatient Appeals Coordinator to lead the preparation, submission, and follow-up of inpatient appeals to maximize reimbursement. You will work with Revenue Cycle, Coding, CDI, Utilization Management, clinicians, and payers to resolve denials and underpayments.

The role requires analyzing denials, gathering medical records, and crafting compelling appeal letters. You will monitor deadlines, track outcomes, and identify trends to reduce preventable denials and

Qualifications

• Minimum 3 to 5 years in inpatient reimbursement and denial/appeal processes.
• Strong knowledge of medical necessity, level of care, coding, and documentation.
• Familiar with Medicare, Medicaid, and commercial payer requirements and appeal timelines.
• Excellent written communication to craft compelling appeal letters.
• Ability to analyze denials and identify appropriate appeal opportunities.
• Strong organizational skills to manage multiple appeals and deadlines.

Responsibilities

• Review inpatient denials and payer determinations to identify appeal opportunities.
• Prepare and submit first-level and subsequent level appeals.
• Coordinate with physicians, CDI, coding, and case management for documentation.
• Monitor deadlines and payer response timelines.
• Maintain documentation of appeal activity and financial impact.
• Identify trends and implement process improvements.

Skills

Inpatient reimbursement

Denials analysis

Payer negotiations

Regulatory compliance

Communication skills

Team collaboration

Documentation accuracy

Education

High School diploma or GED

Associate's Degree preferred

Job description

Care New England is seeking an Inpatient Appeals Coordinator to lead the preparation, submission, and follow-up of inpatient appeals to maximize reimbursement. You will work with Revenue Cycle, Coding, CDI, Utilization Management, clinicians, and payers to resolve denials and underpayments.

The role requires analyzing denials, gathering medical records, and crafting compelling appeal letters. You will monitor deadlines, track outcomes, and identify trends to reduce preventable denials and