DRG Appeals Clinician

Job Summary

A company is looking for a DRG Appeals Clinician, Denials Management (IC).

Key Responsibilities

• Perform retrospective medical necessity reviews to determine appeal eligibility of clinical validation DRG Downgrade denials
• Construct and document a succinct and fact-based clinical case to support appeals using appropriate medical necessity criteria
• Adhere to all coding and clinical documentation guidelines endorsed by ACDIS and AHIMA

Required Qualifications

• RN or MD degree with strong clinical knowledge
• Active unrestricted clinical license in at least one state within the United States
• Certified in coding through either the AAPC (CPC/COC) or AHIMA (CCS/CCS-P)
• Minimum of 5 years recent acute-care hospital experience, preferred
• Minimum of 2 years Utilization Review / Case Management experience within the last 5 years