Acute Coding Appeals Specialist
We are seeking an experienced Acute Coding Appeals Specialist to join our team. In this role, you will leverage advanced inpatient coding expertise to review, analyze, and prepare appeals for Diagnosis Related Group (DRG) denials. The ideal candidate possesses extensive knowledge of ICD-10-CM, ICD-10-PCS, HCPCS, CMS, NCCI, and regulatory guidelines, with the ability to develop well-supported coding appeals based on clinical documentation and industry standards.
Working with minimal supervision, the Acute Coding Appeals Specialist will evaluate coding and billing denials, identify documentation and coding opportunities, and prepare comprehensive appeal letters that support the validity of assigned diagnoses and procedures. This role requires exceptional analytical skills, attention to detail, and the ability to communicate coding rationale effectively.
Key Responsibilities
- Review and prepare appeals for inpatient DRG denials using clinical documentation, coding guidelines, and regulatory standards.
- Apply advanced knowledge of ICD-10-CM, ICD-10-PCS, HCPCS, NCCI, CMS, CMG, and payer-specific guidelines to support coding determinations and appeal outcomes.
- Analyze coding, billing, and documentation issues to identify root causes and recommend corrective actions.
- Research governmental regulations, payer policies, hospital guidelines, Coding Clinic references, and industry standards to support appeal decisions.
- Maintain detailed documentation, tracking spreadsheets, and reports related to appeals, denials, and identified trends.
- Collaborate with coding, Clinical Documentation Integrity (CDI), and client teams to ensure accurate coding supported by clinical documentation.
- Participate in client onboarding and education to gain knowledge of facility-specific coding practices and documentation requirements.
- Assist in educating coding teams regarding appeal outcomes, documentation opportunities, and coding best practices.
- Meet established productivity and quality standards for coding appeals while maintaining coding certification requirements.
- Attend ongoing education sessions to remain current on coding updates, regulatory changes, and payer requirements.
- Deliver exceptional customer service while maintaining professionalism, organization, and attention to detail.
Qualifications:
Minimum of 5 years of inpatient facility coding experience.
Previous experience handling coding appeals, denials, and claim edits.
Advanced knowledge of:
- ICD-10-CM
- ICD-10-PCS
- HCPCS
- MS-DRG assignment
- CMS regulations
- NCCI edits
- Clinical Documentation Improvement (CDI)
- Medical necessity and payer guidelines
Strong understanding of inpatient coding compliance, reimbursement methodologies, and regulatory requirements.
Excellent written communication skills with the ability to develop clear, well-supported appeal letters.
Strong analytical, organizational, and problem-solving abilities.
Proficiency with Microsoft Office, including Excel and Word.
Required Certification
Candidates must possess an active coding credential, such as:
- RHIA
- RHIT
- CCS
- CIC
- CPC
- COC
- Or another nationally recognized coding certification
Compensation
$66,000.00-$66,185.60 YearlyAbout Us
TalentMatch®
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use and Privacy Notice.
