Acute Coding Appeals Specialist

Overview Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy and emphasizes that every touch should be meaningful. By empowering people to challenge the status quo, Ensemble aims to be the difference. O.N.E. Purpose Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our Best in KLAS Ensemble Difference Principles and consistently delivering outstanding results. The Opportunity CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between $29.70 - $31.80 based on experience Position Summary The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities. This role draws on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise to substantiate coding principles and identify potential billing/coding issues and quality concerns. Under indirect supervision, the Coding Appeals Specialist reviews and writes appeals for inpatient Diagnosis Related Group (DRG) denials to support the assigned DRG and address the clinical documentation used in the decision-making process to support the validity of the assigned codes. Job Responsibilities The appeals professional integrates medical coding principles and objectivity in the performance of coding appeals/denials activities, drawing on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS and CMG coding expertise to substantiate coding principles and identify issues and quality concerns. Participates in client system education to gain knowledge necessary to appeal client accounts, ensuring coding is supported by the patient’s clinical documentation, coding/cdi guidelines, and regulatory standards. Maintain meticulous documentation, spreadsheets, accounts, and claim examples of root cause issues. Perform searches of governmental, payor-specific, hospital-specific, regulatory body, and literature rules to identify coding and billing requirements and make recommendations to the client. Assist in education and training for client coding staff as it relates to the outcomes of the coding appeals. Meet established productivity standards for coding appeals and coding certification requirements. Attend in-house sessions to receive updated coding information and changes in coding/regulations. Provide excellent customer service in an organized and efficient manner with a positive attitude. Required Experience Previous inpatient facility coding experience, working appeals, denials and edits 5 years of coding experience required Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements Must be inquisitive and open to innovation including AI to improve processes and experiences This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as needed Minimum Education High School Diploma or GED Required Certification Active Coding Certification (e.g., RHIA, RHIT, CCS, CIC, CPC, COC, etc.) Join An Award-winning Company Five-time winner of Best in KLAS (2020-2022, 2024-2025); Black Book Research's Top Revenue Cycle Management Outsourcing Solution (2021-2024); HFMA MAP Awards for High Performance in Revenue Cycle (2019-2024); Everest Group RCM Operations PEAK Matrix; HBI Revenue Cycle Awards; Energage Top Workplaces USA; Fortune Best Workplaces in Healthcare 2024; Monster Top Workplace for Remote Work 2024; Great Place to Work certified 2023-2024. Innovation Work-Life Flexibility Leadership Purpose + Values Bottom line, Ensemble empowers people with tools and resources to thrive, including: Associate Benefits – comprehensive benefits package supporting health, time off, retirement, and well-being Culture – collaborative, growth-oriented environment that places people first Growth – professional development and tuition reimbursement opportunities Recognition – incentive programs for employees who excel Ensemble is an equal employment opportunity employer. It is our policy not to discriminate based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information, or any other basis protected by law. Ensemble prohibits harassment of applicants or employees based on these categories. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the ADA and applicable state/local law. If you require accommodation in the application process, please contact View email address on click.appcast.io. This posting addresses state-specific requirements to provide pay transparency. Compensation decisions consider factors such as location, knowledge, skills, experience, education, licensure, internal equity, and time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range. Employment Disclaimers – Ensemble #J-18808-Ljbffr