Clinical DRG Denial Specialist

🔥 0 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $37 - $43 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Rochester Regional Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

📚 Education

Healthcare • Healthcare Insurance • Education

Rochester Regional Health is an integrated health services organization serving the people of Western New York. It operates multiple hospitals and healthcare facilities, providing a wide range of healthcare services, including emergency care, primary care, specialty clinics, and urgent care. The organization is committed to medical education and research, offering training programs, residencies, and clinical trials. Rochester Regional Health focuses on comprehensive care with emphasis on treating patients respectfully and meeting their diverse medical needs across all stages of life.

📋 Description

• Ensure accurate and timely resolution of DRG-related payer denials and audit activity • Produce compliant appeal outcomes using clinical, coding, and payer policy knowledge • Maintain contractual, regulatory, and documentation requirements across denial, appeal, and pre-bill review activities • Identify and address documentation, coding, and medical necessity risks before claim submission • Analyze payer trends, denial patterns, and appeal outcomes to improve denial prevention • Maintain denial-related information, requirements, and case status for tracking and reconciliation • Promote standardized denial and appeal practices and efficient workflows • Apply clinical and coding expertise to support accurate DRG assignment, documentation integrity, and reimbursement outcomes

🎯 Requirements

• Degree in Nursing • NYS Registered Nurse Licensure • AS: Health Information Management (Required) • Knowledge of Epic preferred • Proficient in Microsoft Office applications preferred • Practical experience with computerized encoding and grouping software preferred • Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist certification (CCS) preferred • BSN preferred • Ability to work Monday through Friday, 7:00 AM - 3:30 PM