Clin Doc Spec NE

Department/Unit: AMHS - Clinical Documentation Integrity Work Shift: Day (United States of America) Salary Range: $71,612.39 - $110,999.20 This is a Hybrid position. Must reside in New York State. Position Summary: 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. Key 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 Minimum Qualifications: Education: Bacheloru2019s 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 Thank you for your interest in Albany Med Health Systemu200b Albany Med Health System is an equal opportunity employer. This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a u201cneed to knowu201d and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Created: 2026-03-25