In-Patient Coding Denials Specialist

Job Summary :

We are looking for a detail-oriented Inpatient Coding Denials Specialist to analyze and resolve coding-related denials, with a focus on ensuring timely reimbursement and reducing revenue loss. This role requires a solid understanding of inpatient coding guidelines, payer denial patterns, and appeals processes. The ideal candidate is highly analytical, knowledgeable in denial management workflows, and capable of collaborating across teams to improve claim outcomes.

Key Responsibilities :

• Review and analyze denied inpatient claims to identify root causes related to coding, DRG assignment, or documentation.
• Prepare and submit coding-related appeals with supporting clinical and coding references.
• Coordinate with coders, QA, and clinical documentation teams to resolve discrepancies or documentation gaps contributing to denials.
• Track denial trends and provide actionable feedback to reduce future occurrences.
• Stay updated on payer-specific denial policies, coding updates, and audit risk areas.
• Maintain accurate documentation of appeal activities and resolution timelines using internal systems.
• Assist in developing and refining denial prevention strategies, job aids, and internal resources.

Qualifications :

Preferred Skills :