State Licensed Clinical Denial Specialist

Job Summary

A company is looking for a Clinical Denial Specialist - Diagnosis Related Grouping (DRG).

Key Responsibilities

• Manage the review and response to hospital billing audits and denials
• Prepare and submit clinical appeals while negotiating with external auditors
• Collaborate with stakeholders to improve processes and develop educational materials

Required Qualifications

• Associate or Bachelor's degree in healthcare administration, Nursing, Health Information Management, or related field
• Five years of experience in hospital billing or related areas with an associate degree, or three years with a bachelor's degree
• Certification or license in relevant healthcare fields (e.g., RN, LPN, RHIT, RHIA, CCDS, CDIP, CCS, CIC)
• Experience in hospital appeals/denials or HIM/compliance is preferred
• Strong technology skills, including familiarity with Epic, Excel, and DRG groupers