DRG Appeals Clinician
Company: VirtualVocations
Location: Orange
Posted on: February 4, 2025
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Job Description:
A company is looking for a DRG Appeals Clinician, Denials
Management (IC).
Key Responsibilities
Perform retrospective medical necessity reviews to determine appeal
eligibility of clinical validation DRG Downgrade denials
Construct and document a succinct and fact-based clinical case to
support appeals using appropriate medical necessity criteria
Adhere to all coding and clinical documentation guidelines endorsed
by ACDIS and AHIMA
Required Qualifications
RN or MD degree with strong clinical knowledge
Active unrestricted clinical license in at least one state within
the United States
Certified in coding through either the AAPC (CPC/COC) or AHIMA
(CCS/CCS-P)
Minimum of 5 years recent acute-care hospital experience,
preferred
Minimum of 2 years Utilization Review / Case Management experience
within the last 5 years
Keywords: VirtualVocations, Irvine , DRG Appeals Clinician, Other , Orange, California
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