DRG and Clinical Appeals Specialist

Headquarters: Las Vegas, Nevada, United States URL: https://www.secondwaveds.com/ Key Responsibilities  This position is designed as a cross-functional revenue integrity role. While primary responsibilities focus on clinical and DRG appeals, the specialist is expected to support DRG validation audits, coding compliance reviews, clinical validation initiatives, and denial-prevention activities during periods of lower appeals volume. Flexibility and the ability to work across multiple revenue cycle disciplines are essential requirements of the position.    Key Responsibilities  Review denied claims involving DRG downgrades, clinical validation and coding denials.  Conduct a comprehensive analysis of medical records, coded data, physician documentation, laboratory results, imaging findings, treatments, and patient outcomes to identify appeal opportunities.  Draft clear, persuasive, evidence-based appeal letters using clinical indicators, coding guidelines, pa