Clin Doc Spec NE

Albany Medical Center • Saratoga Springs, NY

2d • Hybrid

About The Position

The CDI Denials & Appeals Specialist is responsible for reviewing payer denials, coordinating appeal processes, and ensuring clinical documentation supports accurate coding and reimbursement. This role collaborates with CDI specialists, coding staff, physicians, and revenue cycle teams to reduce denial rates and improve appeal success.

Requirements

• Education: Bachelor’s degree in nursing or health related degree is required MD, DO, MBBS or foreign educated medical graduate with advanced clinical practice experience
• Licensure, Certification & Registration: Valid CDI Certification such as CDIP or CCDS preferred Valid Coding certification such as CCA or CCS preferred Current NYS RN license required for nurses If foreign educated medical graduate, ECFMG certificate preferred
• Experience: Advanced clinical experience with extensive knowledge of complex disease processes and broad clinical practice experience in the inpatient and outpatient settings required CDI experience preferred At least 5 years adult acute care practice experience Demonstrated effective, collegial communication with physicians, other providers, staff and leadership through direct discussion and written communications
• Skills, Knowledge & Abilities: Excellent interpersonal and analytical skills. Must be able to function independently, interpret information, communicate with medical and clinical staff and both internal and external to the institution Able to provide oral presentations both in person and virtually Must be motivated, organized with excellent verbal, written communication skills, and conversant with adult professional learners. Ability to work independently and as a member of a team utilizing critical thinking skills. Demonstrated competence in data analysis and data interpretation. Knowledge of ICD-10 codes and coding guidelines. Ability to prioritize workflow and manage various initiatives. Demonstrated quality improvement knowledge/skills with regard to workflow and productivity processes Strong speaking and writing skills required Excellent presentation skills required Able to produce reports in Microsoft Office components, Word, Power Point, Excel, and Access data bases Demonstrated effective facilitation skills Good listening skills Strong interpersonal communication skills with the ability to relate to all levels of education and organization positions

Responsibilities

• Review and analyze denied claims related to clinical documentation, medical necessity, DRG validation, and coding accuracy
• Prepare and submit timely, well-supported appeal letters using clinical evidence, coding guidelines, and payer policies
• Collaborate with CDI specialists and coding teams to identify documentation gaps contributing to denials
• Work with physicians and clinical staff to clarify documentation and support appeal efforts
• Track and trend denial data to identify root causes and recommend process improvements
• Maintain knowledge of payer rules, CMS regulations, and coding guidelines (ICD-10-CM/PCS, MS-DRGs, APR-DRGs)
• Participate in denial prevention initiatives and education for CDI and clinical teams
• Ensure compliance with organizational policies and regulatory requirements

Benefits

• Excellent health care coverage with no copay at Albany Medical Center providers
• A wide array of services and programs to support emotional, physical, and mental wellbeing

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees