[Hiring] Manager, Appeals & Denials @Accuity

Role Description

The Manager, Appeals & Denials is responsible for the day-to-day management and oversight of the inpatient DRG Downgrades and appeals process. This includes:

• Tracking, prioritizing, and trending denials.
• Writing appeal letters.
• Identifying training and educational opportunities.
• Delivering education to CDI Appeals Specialists, Coders, and DRG Reviewers.

The Manager supports the Appeals & Denials program through:

• Staff oversight.
• Auditing and reporting.
• Mentoring.
• Strengthening client relationships by ensuring the delivery of high-quality appeal letters for Accuity clients.

This position collaborates with various teams to develop appeal letters that support accurate, comprehensive documentation reflecting the true clinical picture of the patient. The Manager utilizes:

• Clinical expertise.
• Clinical documentation improvement practices.
• Current coding guidelines.
• State and federal regulations for ethical coding.
• Facility-specific tools to support best practices and compliance with Accuity’s mission and philosophy.

Qualifications

• Registered Nurse or degree in Healthcare Management, Healthcare Administration, Health Information Management, or another related field required.
• CCDS and/or CDIP certification or RHIA/RHIT certification preferred.
• Minimum of 5 years of appeals/denials or coding experience in the inpatient coding arena.
• Minimum of 5 years of management experience.
• Extensive knowledge of revenue cycle management and coding services.
• Extensive operational knowledge of both physician and hospital revenue cycle.
• Demonstrated knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and modifiers.
• Experience with electronic health records and health information systems.
• Working knowledge of functional relationships between departments within a healthcare or similar environment.
• Demonstrated ability to interpret coding quality audit data, track and trend results, and translate findings into applicable coding education.
• Experience overseeing denials and appeals operations, including scheduling, work distribution, productivity monitoring, and quality output.
• Proficiency using a PC in a Windows environment, including Microsoft Word.

Requirements

• Strong interpersonal and customer service skills.
• Highly motivated and self-directed, with the ability to work effectively in a remote environment.
• Strong analytical and problem-solving skills, with the ability to gather and interpret data, identify areas of opportunity, and apply sound judgment.
• Demonstrated leadership skills, including accountability, decision-making, coaching, and counseling.
• Highly developed written and verbal communication skills.
• Strong organizational and prioritization skills, with the ability to ensure objectives are met in a timely manner.
• Ability to establish and maintain effective, cooperative working relationships with physicians, staff, clients, and cross-functional partners.
• Ability to manage competing priorities while maintaining accuracy, quality, and timely execution.

Benefits

• Less than 5% travel required.
• Exempt FLSA status.