[Hiring] Clinical Appeals & CDI Manager @Managed Resources

Role Description

The Clinical Appeals & CDI Manager will lead a team of clinical professionals responsible for:

• Completing clinical documentation improvement audits
• Developing coding guidelines and evidence-based appeal letters in response to DRG downgrade denials
• Translating audit and denial findings into actionable client education

This role ensures the team delivers high quality clinical and coding documentation review and appeal support resulting in revenue recovery for the client. In addition to managing core appeal and audit functions, this role provides leadership and operational support for special projects to ensure flexible, responsive coverage that meets client needs.

Qualifications

• Registered Nurse (BSN preferred) or Physician
• Minimum of 3-5 years of supervisory or management experience required within clinical documentation improvement, denials/appeals, coding
• One or more of the following certifications is required:
  • Certified Clinical Documentation Specialist (CCDS)
  • Certified Documentation Improvement Specialist (CDIP)
• Certified Coding Specialist (CCS) or other coding credential is preferred
• DRG and Coding Appeal writing experience
• Strong knowledge of DRG methodology, clinical documentation requirements, and payer denial/appeal process
• Ability to lead, coach, and develop a team in a service-level, metrics-oriented environment
• Organizational skills with ability to manage multiple clients, priorities, and deadlines simultaneously
• Excellent written and oral communication skills
• Proficiency in Microsoft Office
• Ability to examine financial and clinical data trends and provide recommended action plans
• Integrity and commitment to excellence

Requirements

• Conduct secondary quality reviews of clinical appeal letters to ensure accuracy, clinical soundness, and compliance with coding, payer, and regulatory requirements prior to submission
• Write clinical appeal letters in response to DRG downgrade denials, applying clinical guidelines, coding standards, and payer-specific criteria to support appropriate reimbursement
• Develop and maintain audit criteria and workflows to ensure consistency, accuracy, and efficiency across the clinical documentation improvement audit process
• Monitor and manage team workload and assignments to ensure timely completion of audits, appeals, and related deliverables in accordance with established service level
• Develop and deliver client education sessions based on audit and denial findings to support improved clinical documentation practices and reduce future denial risk
• Support specialized client projects, including staffing augmentation, as business needs arise
• Supervise, coach, and develop team members to support individual performance, engagement, and professional growth
• Ensure all work is performed in accordance with applicable regulatory, payer, and organizational standards
• Prepare data, analysis, and supporting documentation in response to client inquiries regarding audit findings, denial trends, and appeal outcomes
• Prepare and deliver accurate, timely month-end and quarterly client reports summarizing audit activity, appeal results, and key performance metrics
• Monitor key performance indicators and report any issues/trends/concerns/highlights to leadership
• Proactively identify trends and root causes when department performance does not meet established expectations or key performance metrics, and develop, implement, and track action plans to drive improvement
• Monitor and manage team billable and non-billable activity to ensure monthly profitability targets are met for each assigned client
• Represent the department’s subject matter expertise by actively participating in company communications, webinars, and promotional initiatives that support business development and awareness of the company’s service offerings

Benefits

• Medical, Dental, and Vision Insurance
• Phone and Internet Stipend
• Company-Paid Life Insurance
• 401(k) Retirement Plan with Company Match
• Paid Time Off
• Seven Company-Observed Holidays
• Two Floating Holidays for Personal Observance
• Professional Development Opportunities
• Employee Recognition Programs
• Remote Work Environment