New York Licensed Clinical DRG Specialist

Job Summary

To enhance revenue integrity, the full-time remote New York Licensed Clinical DRG Specialist will apply clinical knowledge and coding principles to manage DRG-related payer denials, ensuring accurate reviews, appeals, and resolutions while identifying risks to prevent avoidable denials.

Key responsibilities

• Ensures accurate and timely resolution of DRG-related payer denials to protect reimbursement and minimize revenue loss
• Produces compliant appeal outcomes by leveraging clinical, coding, and payer policy knowledge for disputed DRG determinations
• Implements denial prevention strategies through analysis of payer trends and denial patterns to enhance operational processes

Required qualifications

• Degree in Nursing
• NYS Registered Nurse Licensure