Piedmont · 2 months ago
DRG Appeals Writer
United States
Full-time
Remote
Senior Level
5+ years expPiedmont Healthcare Corporate is seeking a DRG Appeals Writer who will manage the administrative appeal of reimbursement claims denied by Medicare or Medicaid. The role involves coordination with coding managers and requires a strong understanding of medical coding guidelines, as well as the preparation and drafting of appeals briefs for denied cases.
Hospital & Health Care
Responsibilities
Managing the administrative appeal of reimbursement claims denied by Medicare or Medicaid on the grounds that the medical coding was incorrect
Coordination of activities with the managers of coding at each of the Piedmont affiliated hospitals and physician practices as well as the Senior Director of Government Appeals
Maintaining a high level of understanding of DRGs and MS/DRGs, ICD-9-CM Official Guidelines for Coding and Reporting, American Hospital Association Coding Clinic guidelines, federal guidelines for coding Medicare inpatient records, state guidelines for coding Medicaid records, Utilization Review ('UR') regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation
Resolving differences of opinions among coders as to the most appropriate code
Preparing the coding appeals; performing a detailed review, analysis and extraction of clinical and coding information from patient medical records
Drafting effective narratives for Medicare and Medicaid appeals briefs in support of denied cases throughout appeals at all levels of the government appeals process
Testifying in appeal hearings before an administrative law judge as an expert in medical coding
Qualification
Required
Bachelor's Degree Bachelor's degree Required
In lieu of degree, six (6) years of relevant work experience will be accepted in addition to the experience requirement Required
5 years of inpatient coding experience and of DRG-MS/DRG auditing experience in a healthcare setting Required
Experienced medical record/DRG coder/auditor with a working knowledge of ICD-10 guidelines, case management, government and contracted payers Required
Must be experienced in clinical, coding and patient financial services software such as 3-M Encoder, SCM / Quest, STAR, EPIC, Client Tracking, and I-Suites Required
In lieu of degree (, a total of eleven (11) years of experience ) Required
Experience in coding at a multi-facility organization and remote coding experience is a plus Required
One or more certifications - Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), CCA, CCS-P, CPC, CPC-H Required
Preferred
Coding Certificate program (AHIMA accredited) Preferred
Master's degree Master's degree Preferred
Previous experience writing DRG Appeals Preferred
Previous experience with RAC claims denials Preferred
Company
Piedmont
Piedmont is empowering Georgians by changing health care.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Angela Herrington
Chief Executive Officer
Dr. Charles L. Brown, III
CEO, Physician Enterprise
Recent News
2025-09-02
2025-08-25
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