Inpatient Hospital Coder – Denial Appeals Specialist

PayerWatch, Inc.; United States; À distance; USD 34 000 - 55 000; Temps partiel

Résumé du poste

PayerWatch, Inc. is seeking an experienced Inpatient Hospital Coder – Denial Appeals Specialist to review, analyze, and write compelling appeals for coding and DRG-related denials.

This remote 1099 contract role requires a minimum commitment of ten appeals per week (approximately 15–20 hours weekly) and independent work with your own equipment. The ideal candidate will have mid-level inpatient coding experience, strong knowledge of ICD-10-CM/PCS, payer policies, and reimbursement principles.

Qualifications

• Inpatient coding experience with MS-DRG expertise.
• Ability to translate complex medical information into persuasive appeals.
• Understanding of payer policies and reimbursement principles.
• Familiarity with HIPAA and confidentiality.

Responsabilités

• 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.

Connaissances

ICD-10-CM/PCS knowledge

Inpatient coding experience

Analytical writing

Description du poste

Job Position: Independent Medical Reviewer
Reports To: Chief, Clinical Business Operations
Department: AppealMasters

Employment Status:

• 1099 Independent Contractor (Remote)
• This remote contractor role requires a minimum commitment of ten appeals per week (approximately 15–20 hours weekly). Contractors are responsible for providing their own equipment and maintaining a secure home office environment.

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. The ideal candidate will have mid-level inpatient coding experience and the ability to translate complex coding and clinical information into clear, concise, and well-supported appeal arguments. The primary responsibility of this role is to develop accurate, evidence-based denial appeals that support appropriate reimbursement.

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.