Coding Audit & Appeals Specialist
TriHealth · United States
Join TriHealth as a Coding Audit & Appeals Specialist!
TriHealth offers Coding Audit & Appeals Specialists the opportunity to make a meaningful impact by protecting revenue, reducing financial loss, and ensuring accurate, compliant coding practices across the organization. In this role, you’ll apply your expertise in ICD‑9, ICD‑10, DRG, CPT, CDI, and hospital billing to resolve complex denials, collaborate with payers, and craft effective appeals that support maximum reimbursement. You’ll serve as a trusted resource to billing teams and internal partners, helping them navigate coding issues, interpret regulations, and maintain standardized, high‑quality coding and billing procedures.
As one of Cincinnati’s most respected healthcare employers, TriHealth provides a supportive, collaborative environment where your technical knowledge and problem‑solving skills are valued. You’ll work closely with multiple departments, stay current on evolving coding guidelines, and contribute to a culture committed to accuracy, compliance, and service excellence. TriHealth invests in its people - offering stability, professional growth, and the chance to build a rewarding career while advancing the organization’s mission of delivering exceptional care.
Apply today and grow your career with a team that truly values you.
Location:
TriHealth in Norwood at 4685 Forest Ave, Cincinnati, OH 45212
Work Schedule:
Full-Time (80 hours biweekly)
Day Shift
No Weekend, Holiday or On Call Commitment
Benefits:
In addition to a comprehensive benefits package - including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement. Please view our benefits page https://careers.trihealth.com/what-we-offer/benefits
Job Requirements:
Associate's Degree in Coding RHIT (Associates) (Required)
3 - 4 years experience in related field (Required)
Billing/Payer knowledge of hospital billing
Must be familiar and experienced with CDI. ICD-9, ICD-10, DRG
CPT Coding guidelines
Medical terminology
Physiology
Other Insurance\Certified Pension Consultant (CPC) Upon Hire Required
Other CCS-Certified Coding Specialist Upon Hire Required
Other CMC - Cardiac Medicine-Subspecialty Certification Upon Hire Required
Other CCA - Certified Coding Associate Upon Hire Required
Job Overview:
Principal purpose is to expedite hospital coding denials to ensure maximum reimbursement and to reduce/eliminate financial loss to department customers. Contact payers regarding coding issues and using appeal letters to reduce fatal denials. Provides coding expertise to billing teams to assist in proper billing
Job Responsibilities:
Assists with billing/coding questions from both internal and external customers which include, following up on denials, review of charts and coding issues.
Backs up for team members within Payroll and all other special assignments from Payroll Director.
Ensures understanding and compliance with coding protocols, rules and regulations from government agencies, insurance carriers, and other resources.
Maintains a close working relationship with all departments and consolidates efforts to ensure appropriate and standardized coding/billing procedures are followed.
Maintains knowledge of current coding revisions.
Resolves coding issues that arise within the patient accounting departments and provides coding support.
Works directly with the billing teams to ensure denials for coding are appealed and followed up on appropriately, and in a timely manner.
Working Conditions:
Climbing - Rarely
Concentrating - Consistently
Continuous Learning - Consistently
Hearing: Conversation - Frequently
Interpersonal Communication - Frequently
Kneeling - Rarely
Lifting <10 Lbs. - Rarely
Lifting 50+ Lbs. - Rarely
Lifting <50 Lbs. - Rarely
Pulling - Rarely
Pushing - Rarely
Reaching - Rarely
Reading - Consistently
Sitting - Consistently
Standing - Rarely
Stooping - Rarely
Thinking/Reasoning - Consistently
Use of Hands - Frequently
Color Vision - Consistently
Walking - Occasionally
TriHealth SERVE Standards and ALWAYS Behaviors
At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:
Serve: ALWAYS...
- Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
- Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
- Refrain from using cell phones for personal reasons in public spaces or patient care areas
Excel: ALWAYS...
- Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
- Offer patients and guests priority when waiting (lines, elevators)
- Work on improving quality, safety, and service
Respect: ALWAYS...
- Respect cultural and spiritual differences and honor individual preferences.
- Respect everyone's opinion and contribution, regardless of title/role.
- Speak positively about my team members and other departments in front of patients and guests.
Value: ALWAYS...
- Value the time of others by striving to be on time, prepared and actively participating.
- Pick up trash, ensuring the physical environment is clean and safe.
- Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Engage: ALWAYS...
- Acknowledge wins and frequently thank team members and others for contributions.
- Show courtesy and compassion with customers, team members and the community