Senior DRG Appeals Analyst — Remote

Rush University Medical Center; Chicago (IL); Remote; USD 48,000 - 70,000; Full time

Job summary

Rush University Medical Center in Chicago seeks a Senior DRG Appeals Coding Analyst to lead complex DRG and clinical validation appeals. You will review audits, write evidence‑based letters, and defend DRG assignments, collaborating with CDI, Compliance, and Revenue Cycle teams.

The ideal candidate has inpatient coding expertise, strong written communication, and a commitment to accuracy, compliance, and revenue optimization. This role offers remote work with a full‑time schedule.

Qualifications

• High School Diploma or GED
• AHIMA Coding certification
• 3 coding audits or 5 years coding experience
• Ability to interpret and analyze medical records
• Proficiency in Microsoft Suite and Excel
• Epic Experience
• Excellent verbal and written communication skills
• Ability to communicate effectively with providers and hospital leadership
• Meets productivity guidelines and targets

Responsibilities

• Review, analyze, and respond to DRG audits related to principal diagnosis, MCC/CC, SOI, procedures, and clinical validation denials to determine validity and strategy.
• Write clear, evidence‑based appeal letters linking documentation and clinical indicators to payer criteria.
• Audit inpatient records to validate DRG assignments per ICD‑10‑CM/PCS guidelines.
• Identify clinical indicators supporting DRG, SOI, and resource use.
• Prepare appeals with references to ICD‑10‑CM/PCS guidelines, CMS/MS‑DRG definitions, and payer policies.
• Clearly articulate SOI criteria focused on payer validation requirements.
• Ensure all submissions meet CMS, OIG, and regulatory standards.
• Support audits with rationale and evidence across systems.
• Collaborate with Inpatient Coders and CDI for second-level reviews and denial trends.
• Work with CDI to request reviews and identify documentation gaps
• Partner with Compliance and ERM to mitigate risks from denials and downgrades

Skills

Verbal and written communication

Analytical skills

Interpreting medical records

Productivity/meeting targets

Education

AHIMA Coding certification

Tools

Epic Experience

Microsoft Excel

Microsoft Office

Job description

Rush University Medical Center in Chicago seeks a Senior DRG Appeals Coding Analyst to lead complex DRG and clinical validation appeals. You will review audits, write evidence‑based letters, and defend DRG assignments, collaborating with CDI, Compliance, and Revenue Cycle teams.

The ideal candidate has inpatient coding expertise, strong written communication, and a commitment to accuracy, compliance, and revenue optimization. This role offers remote work with a full‑time schedule.