Florida Licensed DRG Denial Specialist

Job Summary

To support a growing healthcare practice, the full-time Florida Licensed DRG Denial Specialist will review DRG-related payer denials, author appeal letters based on clinical documentation, and collaborate with a Physician Advisor remotely.

Key responsibilities

• Review clinical validation and coding-related DRG denials to determine if an appeal is warranted
• Author clear and well-supported DRG appeal letters defending or clarifying DRG assignments
• Collaborate with Physician Advisors and expert coders on complex cases requiring combined expertise

Required qualifications

• At least 3 years of recent inpatient coding, CDI, or denial management experience
• Prior experience authoring DRG appeal letters is required
• Strong coding knowledge, including ICD-10-CM/PCS and MS-DRG/APR-DRG classification systems
• Expert-level knowledge of evidence-based standards for clinical validation of commonly denied diagnoses
• Strong understanding of Official Coding Guidelines and Coding Clinic guidance