Clinical DRG Denials Specialist

🔥 0 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $37 - $43 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

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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

• Applies clinical knowledge, coding principles, payer policy interpretation, and documentation review to support appropriate reimbursement and regulatory compliance • Ensures accurate and timely resolution of DRG-related payer denials and audit activity • Produces well-supported and compliant appeal outcomes by applying clinical, coding, and payer policy knowledge • Maintains adherence to contractual, regulatory, and documentation requirements • Strengthens revenue integrity by identifying and addressing documentation, coding, and medical necessity risks • Improves denial prevention performance through analysis of payer trends, denial patterns, and appeal outcomes • Ensures denial-related information is consistently maintained for accurate tracking • Promotes effective, standardized denial and appeal practices • Applies specialized clinical and coding expertise to support accurate DRG assignment and sustainable reimbursement outcomes

🎯 Requirements

• Degree in Nursing • NYS Registered Nurse Licensure • Knowledge of Epic preferred • Proficient in Microsoft Office applications preferred • Practical experience with computerized encoding and grouping software preferred • Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) or Certified Coding Specialist certification (CCS) preferred • BSN preferred.