Appeals Specialist

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.