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CDI Denials and Appeals Specialist

Job Overview

CDI Denials and Appeals Specialist


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The Coding Denial Specialist performs advanced level work related to coding denial management. The individual is responsible for managing claim denials related to coding. The Coding Denial Specialist conducts comprehensive reviews of the claim denial, clinician notes associated with the denial, and the medical record to make determinations if a revised claim needs to be submitted, if a written appeal is needed, or if no action is needed.


The Coding Denial Specialist writes and submits professionally written appeals which include compelling arguments based on coding documentation, official coding references, and contract language. Appeals are submitted timely and tracked through final outcome. The incumbent will also handle audit-related / compliance responsibilities and other administrative duties as required.


This incumbent will actively manage, maintain, and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management. Additionally, the Coding Denial Specialist anticipates and responds to a wide variety of issues/concerns. The incumbent works independently to plan, schedule, and organize activities that directly impact hospital and physician reimbursement and assists in creating and maintaining documentation of key processes. This role is key to securing reimbursement and minimizing organizational write offs.



Core Responsibilities:

  • Research payer denials related to coding and billing resulting in denials and delays in payment.
  • Independently write professional appeal letters.
  • Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as UW Health policies and procedures.
  • Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.
  • Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.
  • Review payor communications, identifying risk for loss reimbursement related to coding policies and escalates potential issues to coding stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate.
  • Identify opportunities for process improvement and actively participate in process improvement initiatives.


Customer Service Standards:

  • Support co-workers and engage in positive interactions.
  • Communicate professionally and timely with internal and external customers.
  • Provide helpful assistance in anticipating and responding to the needs of our customers.
  • Collaborate with customers in planning and decision making to result in optimal solutions.
  • Ability to stay calm under pressure and deal effectively with difficult people











Associate degree in a business or healthcare related field. Two (2) years of relevant experience may be considered in lieu of a degree in addition to the required experience below.


Bachelor’s Degree in healthcare related field

Work Experience


Two (2) years recent experience in writing of denials


  • Multiple hospital EMR experience
  • Three (3) years of experience in a healthcare revenue cycle operations role with one (1) of those years being in a role which included claim-related appeal writing.
  • Experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, 1500)

Licenses & Certifications




AHIMA or ACDIS related credential

Required Skills, Knowledge, and Abilities

  • Focus on continuous process improvement
  • Ability to make good judgments in demanding situations
  • Ability to react to frequent changes in duties and volume of work
  • Effective communication skills
  • Extensive writing capabilities / efficiencies
  • Ability to write professional appeal letters
  • Ability to organize details logically and accurately
  • Ability to construct an effective argument to justify a hospital service.
  • Ability to effectively communicate in writing.
  • Ability to communicate with multiple levels in the organization (e.g, managers, physicians, coding and support staff)
  • Ability to maintain a strong relationship with various coding and non-coding team members to positively affect financial outcomes
  • Ability to manage multiple tasks with ease and efficiency
  • Self-starter with a willingness to try new ideas
  • Ability to work independently and be result oriented
  • Positive, can-do attitude coupled with a sense of urgency
  • Effective interpersonal skills, including the ability to promote teamwork
  • Strong problem-solving skills
  • Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders
  • Ability to use various computer applications
  • Excellent PC operating skills (keyboard, mouse) and use of MS Office
  • Broad knowledge of health care business office practices and principles
  • Basic math skills and knowledge of general accounting principles
  • Maintain confidentiality of sensitive information
  • Knowledge of Business Office policies and procedures
  • Knowledge of Medicare, Medicaid and third-party reimbursement methodologies
  • Knowledge of local, state and federal healthcare regulations


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