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
Lead and manage the full-service delivery operation across all three service lines: Revenue Cycle Management, Medical Software Management, and Population Health Management.
Locations (2)
Canonsburg, Pennsylvania, United States
Pittsburgh, Pennsylvania, United States
Compensation
Salary plus bonus opportunity!
Responsibilities
Lead and manage the full-service delivery operation across all three service lines
Serve as the operational authority on every dimension of successful private practice management
Oversee the physician practice conversion program
Ensure every client practice receives accurate, timely, compliant service delivery
Direct oversight of the RCM team and all billing operations
Requirements
MBA
MHA
Nice to have: Professional Coder (CPC)
Nice to have: Certified Revenue Cycle Professional (CRCP)
