Health Business Solutions LLC
IP Coding Appeals Specialist
Job Summary:
The IP Coding Appeals Specialist is responsible for reviewing inpatient (IP) coding denials, preparing and submitting appeals, and ensuring accurate clinical documentation supports appropriate reimbursement. This role works closely with coding, CDI, and payer guidelines to overturn denied claims and optimize revenue recovery.
Key Responsibilities:
Review and analyze inpatient coding denials from payers (e.g., DRG downgrades, medical necessity denials)
Interpret medical records to validate accurate ICD-10-CM/PCS coding and DRG assignment
Prepare and submit detailed, evidence-based appeal letters within payer timelines
Collaborate with Clinical Documentation Improvement (CDI) teams and coders to identify documentation gaps
Ensure compliance with payer-specific guidelines, CMS regulations, and coding standards
Track appeal outcomes and maintain documentation for reporting and audit purposes
Identify denial trends and provide recommendations to reduce future denials
Communicate with insurance payers when additional clarification or follow-up is required
Maintain productivity and quality standards as defined by the organization
Qualifications:
Bachelor’s degree in Health Information Management, Nursing, or related field (preferred)
Minimum 2–4 years of inpatient coding and/or denial appeals experience
Strong knowledge of:
ICD-10-CM and ICD-10-PCS coding systems
MS-DRG classification and reimbursement methodologies
Medical terminology, anatomy, and physiology
Experience handling payer denials and writing appeals (clinical and coding-based)
Familiarity with CMS guidelines and commercial payer policies
Certifications:
One of the following required or preferred:
CCS (Certified Coding Specialist)
CPC (Certified Professional Coder) with inpatient experience
RHIT or RHIA
Skills & Competencies:
Strong analytical and critical thinking skills.
Excellent written communication (for appeal letters)
Attention to detail and accuracy
Ability to interpret clinical documentation and payer policies
Time management and ability to meet deadlines
Proficiency in EHR systems and coding/abstracting tools