Clinical DRG Denial Specialist - Riedman - Remote, Health Information Management (Full-Time, Days)

Responsibilities

• Ensures accurate and timely resolution of DRG-related payer denials and audit activity in order to protect reimbursement and minimize avoidable revenue loss.
• Produces well-supported and compliant appeal outcomes by applying clinical, coding, and payer policy knowledge to disputed DRG determinations.
• Maintains adherence to contractual, regulatory, and documentation requirements across denial, appeal, and pre-bill review activities to support compliance and payment integrity.
• Strengthens revenue integrity by identifying and addressing documentation, coding, and medical necessity risks before claim submission.
• Improves denial prevention performance through analysis of payer trends, denial patterns, and appeal outcomes, leading to responsive strategies and process enhancements.
• Ensures denial-related information, requirements, and case status are consistently maintained to support accurate tracking, reconciliation, and operational visibility.
• Promotes effective, standardized denial and appeal practices that support efficient workflows and consistent organizational response to payer challenges.
• Applies specialized clinical and coding expertise to support accurate DRG assignment, documentation integrity, and sustainable reimbursement outcomes across the revenue cycle.

Requirements

• Degree in Nursing
• NYS Registered Nurse Licensure
• Preferred: 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

Qualifications

• AS: Health Information Management (Required)

Physical Requirements

• Sedentary Work - Exerting up to 10 pounds of force occasionally

Pay

$37.50 - $43.25 per hour