Inpatient Hospital Coder Denial Appeals Specialist

Sacbar; Towson (MD); Hybrid; USD 75,000 - 105,000; Full time

Job summary

Sacbar is seeking an experienced Inpatient Hospital Coder – Denial Appeals Specialist in Towson, MD to review and write compelling appeals for DRG-related denials. The role requires strong inpatient coding knowledge, MS-DRG assignment, clinical documentation, payer policies, and reimbursement principles.

The candidate will analyze medical records, apply ICD-10-CM/PCS guidelines, and collaborate with CDIS and revenue cycle teams to strengthen appeals.

Qualifications

• 2–5 years of inpatient hospital coding experience.
• Strong knowledge of ICD-10-CM, ICD-10-PCS, and MS-DRG methodology.
• Experience reviewing inpatient medical records and interpretations.
• Proven experience with coding and/or DRG denial appeals.
• Solid understanding of inpatient coding guidelines and regulatory requirements.
• Excellent written communication skills for persuasive appeals.
• Strong analytical and critical-thinking abilities.
• Ability to independently research coding and reimbursement issues.

Responsibilities

• Review inpatient coding and DRG denial cases to identify denial reasons and determine appeal strategy.
• Analyze medical records, coding, clinical documentation, and payer denial rationale.
• Write detailed, persuasive appeals addressing coding, sequencing, and DRG-related denials.
• Apply ICD-10-CM/PCS guidelines and other coding standards.
• Evaluate MS-DRG assignments and discrepancies between documentation and payer determinations.
• Research coding guidelines, CMS regulations, and payer policies to support appeals.
• Explain clinical and coding rationale supporting original codes or DRG assignments.
• Identify opportunities to strengthen appeals through additional documentation or regulatory support.
• Collaborate with CDIS, coding leadership, and revenue cycle teams as needed.
• Maintain documentation of appeal activity and outcomes.
• Monitor denial trends and identify recurring issues for education or process improvement.
• Meet productivity, quality, accuracy, and turnaround-time standards.
• Maintain HIPAA confidentiality and organizational policies.

Skills

Inpatient coding

MS-DRG knowledge

ICD-10-CM/PCS

Written communication

Analytical thinking

Research skills

Time management

Attention to detail

Education

Coding certification

Job description

Position Summary

We are seeking an experienced Inpatient Hospital Coder – Denial Appeals Specialist to review, analyze, and write compelling appeals for coding and DRG-related denials. This position requires a strong understanding of inpatient coding guidelines, MS-DRG assignment, clinical documentation, payer policies, and reimbursement principles.

Key Responsibilities

• Review inpatient coding and DRG denial cases to identify the reason for denial and determine the appropriate appeal strategy.
• Analyze medical records, coding, clinical documentation, and payer denial rationale.
• Write detailed, persuasive appeals addressing coding, sequencing, diagnosis/procedure assignment, and DRG-related denials.
• Apply ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting and other applicable coding standards.
• Evaluate MS-DRG assignments and identify discrepancies between the documented clinical circumstances and the payer's determination.
• Research and reference applicable coding guidelines, CMS regulations, payer policies, and other authoritative sources to support appeals.
• Clearly explain the clinical and coding rationale supporting the original code or DRG assignment.
• Identify opportunities to strengthen appeals through additional documentation, coding guidance, or regulatory support.
• Collaborate with clinical documentation specialists, coding leadership, utilization review, and other revenue cycle professionals as needed.
• Maintain accurate documentation of appeal activity, outcomes, and supporting rationale.
• Monitor denial trends and identify recurring coding or DRG issues that may require education or process improvement.
• Meet established productivity, quality, accuracy, and turnaround-time standards.
• Maintain confidentiality and comply with HIPAA and organizational policies.

Qualifications

• 2–5 years of inpatient hospital coding experience or equivalent experience.
• Strong knowledge of ICD-10-CM, ICD-10-PCS, and MS-DRG methodology.
• Experience reviewing and interpreting inpatient medical records.
• Demonstrated experience with coding and/or DRG denial appeals.
• Strong understanding of inpatient coding guidelines and regulatory requirements.
• Excellent written communication skills with the ability to develop clear, logical, and persuasive appeal arguments.
• Strong analytical and critical-thinking skills.
• Ability to independently research coding and reimbursement issues.
• High level of attention to detail and accuracy.
• Ability to manage multiple appeals and meet established deadlines.