Clinical Denials & Appeals Auditor

Start Date: 8/31/2026

Pay Rate

$45.00 - $60.00 per hour

Qualifications

• CDIP or CCDS and/or RN Preferred
• CCS, RHIA or RHIT preferred
• CPMA (Certified Professional Medical Auditor) is a plus
• Minimum of three to five years ongoing inpatient coding and abstracting experience in ICD-9-CM, ICD-10-CM/PCS and DRGs
• 3-4 years of Clinical Documentation high-level review experience required, with experience in mortality risk, PSI, medical necessity, and HACs
• Minimum of two years auditing experience

Systems

• 100% 3M 360 CAC & Encoder
• Cerner, eCharms, Legacy, Medhost abstracting, (HMS)

About the Role

Performs inpatient coding DRG denial audits of RAC and non-RAC payer accounts for the HIIM Department at the Corporate office. Reviews patient records for accuracy in ICD-9-CM coding, ICD-10-CM/PCS, DRG assignment, present on admission indicators (POA), discharge disposition, and any other pertinent data needed to capture coding accuracy. Provides audit feedback via the auditing process to pertinent parties, such as HIM Director and Corporate Coding Manager. Assists in preparation of the monthly and quarterly denials audit reports.

Applied knowledge of medical terminology, pathophysiology, and pharmacology. Demonstrates tested data quality and integrity skills.

Responsibilities

• Performs inpatient coding denial review using ICD-9-CM, ICD-10-CM/PCS, DRG validation (3M coding software) utilizing appropriate coding references for CHS hospitals via scanned, electronic, and hybrid medical records
• Utilizes hospital abstracting system for coding validation when applicable
• Prepares preliminary results for review by the requesting party
• Reviews DRG change disagreements with the Director, Coding Denials and Appeals
• Assists in preparation of the final quarterly audit reports for Division VPs, AVPs, facility CEOs, CFOs, Regional HIM Directors, and VP of HIIM
• Provides coder education via email and phone on all audits and uses applicable coding references
• Maintains productivity levels set forth by the HIIM Department and interdepartmental policy while maintaining a 97% accuracy rate by third-party auditors
• Consults with Director, Coding Denials and Appeals during any audit discrepancies
• Attends coding workshops as necessary to maintain coding credentials
• Keeps abreast of regulatory changes affecting coding rules and regulations
• Maintains proficiency in the Official Coding Guidelines for coding and reporting and the AHA Coding Clinics
• Other duties as assigned by Director, Coding Denials and Appeals

Skills

• Thorough knowledge of the related inpatient prospective payment systems (IPPS)
• Experience in working DRG coding denials and writing appeal letters to government and non-government payers
• Experience preserving coding integrity based on Coding Guidelines, Coding Clinic, and appropriate coding references and resources
• Broad knowledge of pharmacology indications for drug usage and related adverse reactions
• Knowledge of anatomy, physiology, and medical terminology
• Understanding of coding practices and official guidelines
• Experience with PC, mainframe applications, and encoding systems
• Auditing skills for coding quality and compliance
• Strong process management skills

Location

Franklin, close neighbor to the much larger Nashville, is a livable city with a lovely historic downtown. The city's Main Street bustles with thriving small businesses and eateries, offering visitors and residents no shortage of entertainment options. The Franklin Theatre, established in 1937, is a cultural icon, boasting an ever-impressive roster of regional and national touring musicians and showing classic movies on a weekly basis. Two annual Main Street Festivals reinforce the vibrant identity of the city, and Pumpkinfest is a resident favorite, welcoming in autumn in style.

Benefits

• Medical, dental, and vision benefits
• Earned time off and paid holidays
• Paid continuing education time
• 401(K) retirement planning
• Short-term disability, life insurance, paid jury duty
• Access to the largest network of facilities and providers in the country
• Industry-experienced workforce management team
• Licensure and certification reimbursement