DRG Appeals Specialist - Health Information
University of California, Irvine · Posted Nov 9, 2026
- Orange, California, United States
- On-site
- Full-time · Mid
- 5+ years
The DRG Appeals Specialists will review and analyze denied/downgraded MS DRG and APR-DRG accounts received from payers (e.g. Medicare, Commercial and Third Party). Using coding expertise the specialist will determine if the denied/downgraded account is appealable. When applicable the specialist will prepare an appeal letter based on current coding guidelines and clinical criteria, as well as track and trend denial root causes so documentation/coding opportunities for improvement are identified.
Responsibilities
- Review and analyze denied/downgraded MS DRG and APR-DRG accounts from payers
- Determine if denied/downgraded accounts are appealable using coding expertise
- Prepare appeal letters based on current coding guidelines and clinical criteria
- Track and trend denial root causes to identify documentation/coding opportunities for improvement
Requirements
- CCS credential
- Nice to have: Clinical Documentation Improvement
- Nice to have: Prior denial management
- Nice to have: EPIC