Job Summary

The IP Coding Appeals Specialist is responsible for reviewing inpatient (IP) coding denials, preparing and submitting appeals, and ensuring accurate clinical documentation supports appropriate reimbursement. This role works closely with coding, CDI, and payer guidelines to overturn denied claims and optimize revenue recovery.

Key Responsibilities

• Review and analyze inpatient coding denials from payers (e.g., DRG downgrades, medical necessity denials).
• Interpret medical records to validate accurate ICD-10-CM/PCS coding and DRG assignment.
• Prepare and submit detailed, evidence-based appeal letters within payer timelines.
• Collaborate with Clinical Documentation Improvement (CDI) teams and coders to identify documentation gaps.
• Ensure compliance with payer-specific guidelines, CMS regulations, and coding standards.
• Track appeal outcomes and maintain documentation for reporting and audit pu...