Posted 2d ago

Appeals Specialist

@ Springhill Medical Center
Mobile, Alabama, United States
OnsiteFull Time
Responsibilities:appeal writing, denial analysis, coding review
Requirements Summary:Minimum 2 years of experience with clinical validation denials, DRG downgrades, and appeal writing; strong ICD-10 knowledge; payer audit experience; proficient in EMRs and MS Office.
Technical Tools Mentioned:Electronic Medical Records, Microsoft Office
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Job Description

Pre-Employment Requirements:

  • We are a drug free facility. Passing a pre-employment drug screening is required.

Education/Experience Requirements: 

  • Current RN License, BSN preferred. 
  • Minimum of 2 years of experience with clinical validation denials, DRG downgrade denials, and appeal writing.
  • Strong understanding of ICD-10 coding guidelines and clinical documentation standards.
  • Knowledge of payer audit processes, RACs, commercial payer reviews, and denial rationale interpretation.
  • Excellent written communication and clinical documentation analysis skills.
  • Strong critical thinking and attention to detail.
  • Proficiency with electronic medical records and Microsoft Office applications.