DRG and Clinical Appeals Specialist
Second Wave Delivery Systems Is this your company? Claim it · Remote (USA Only) · Full-time
Description
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, payer policies, Coding Clinic guidance, and CMS regulations. Prepare first-level and second-level appeals and reconsideration requests for commercial, Medicare, Medicare Advantage, and Medicaid payers. Defend the clinical v…
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Questions about this job
Where is this DRG and Clinical Appeals Specialist job located?
It is listed as Remote (USA Only), so it can be done from home.
Who is hiring?
The employer shown on the listing is Second Wave Delivery Systems.
What is the salary?
The listing does not state a salary. Ask the employer about pay, overtime and payment dates before accepting.
Is it full-time or part-time?
The listing type is Full-time.
When was this job posted?
It was posted on 14 November 2026. Jobs that stay open too long are closed automatically, so apply soon if you are interested.
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