DENIAL COORDINATOR-RN in Hattiesburg, Mississippi at Forrest General Hospital

Job Summary:

The Denials Coordinator-RN is responsible for reviewing, analyzing, and appealing Diagnosis Related Group (DRG) downgrade denials from payers to ensure accurate reimbursement and compliance with coding and documentation guidelines. This role works closely with coding, clinical documentation improvement (CDI), case management, and revenue cycle teams to defend hospital claims and reduce revenue loss.

Performance Expectations:

• Review payer denials related to DRG downgrades to determine validity based on coding guidelines, clinical documentation, and regulatory requirements.
• Analyze medical records to confirm correct DRG assignment and identify opportunities for appeal.
• Prepare and submit detailed, evidence-based clinical and coding appeals to payers within required timeframes.
• Collaborate with coding, CDI, and compliance teams to ensure alignment on DRG assignments and appeal strategies.
• Track, monitor, and report denial trends to identify root causes and recommend process improvements.
• Assist in developing education and training materials for coding and CDI staff to prevent future denials.
• Maintain knowledge of ICD-10-CM/PCS coding guidelines, MS-DRG/APR-DRG methodology, payer policies, and CMS regulations.
• Ensure compliance with HIPAA and other regulatory requirements while handling patient health information.

Qualifications

Education & Certification

• Associate’s or Bachelor’s degree in Health Information Management, Nursing (LPN or RN), or related field required.
• RHIA or RHIT credential preferred.
• Epic, Cerner, or other EHR certification preferred.

Experience

• • 2–4 years of inpatient coding, CDI, or clinical appeals experience.
  • Strong knowledge of MS-DRG/APR-DRG assignment, ICD-10-CM/PCS coding, and clinical documentation standards.
  • Experience with payer denials, appeals, and revenue cycle processes.

Skills & Competencies

• • Ability to work independently
  • Excellent written communication and analytical skills.
  • Ability to interpret and apply coding guidelines and clinical criteria.
  • Proficient in EMR systems and denial management software.

Performance Indicators:

• Appeal overturn success rate.
• Denial prevention through coding and CDI collaboration.
• Timeliness of appeal submissions.
• Contribution to revenue integrity and compliance goals.

Mental Demands:

Exceptional oral and written skills are required to relate effectively to Hospital staff, medical staff, and

Regulatory agencies. The individual must have a high energy level and be capable of handling pressure

situation both mentally and physically. Knowledge of Joint Commission Standards and other regulatory agency requirements is essential. Exceptional analytical skills are necessary to perform required data analysis.