Description

Job Schedule: Per Diem
Standard Hours: 1
Job Shift: Shift 1
Shift Details:

Work where every moment matters.

Every day, approximately 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

JOB SUMMARY

The Denials Specialist 1 is responsible for HIM Coding denial resolution and prevention activities consistent with regulatory and healthcare revenue cycle industry standards. Communicates and educates on any identified coding denial trends.

JOB RESPONSIBILITIES

Denials Resolution

• Works with coding staff to investigate and resolve coding related denials.
• Conducts account research and works with others as needed to determine the appropriate course of denial appeals.
• Collaborates with clinical staff and/or outside providers to obtain further information to be used in the coding and appeals process.
• Creates written appeals utilizing official coding guidelines, coding clinic, and CPT assistant or other resources as appropriate.
• Assists with processing HIM Coding validation denial and audit finding letters to third party vendor (HROI).
• Monitors and follows up on appeals to ensure appeal has resulted in an overturned denial or has escalated through the proper channels.
• Meets revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards).

Denials Prevention

• Identifies complex denial coding issues adversely impacting the HIM Coding team and communicates findings to Manager.

Education

• Provides education and training on identified coding denial trends and recommended remediation.

Communication

• Escalates or communicates coding denials to appropriate departments per established process. (Coding, Billing, Compliance, etc.)

Other

• Runs reports and analyzes coding and denials data per requests from HIM coding teams as needed.
• Participates in general or special assignments and other duties as assigned.
• Mentors new and existing team members on denials initiatives.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines

Qualifications

REQUIREMENTS AND SPECIFICATIONS

Education:

• Associate Degree or equivalent

Experience

• Two years of progressive on-the-job coding experience in an acute care hospital setting required.
• One year denials review, auditing, management, and/or coder training experience.

Licensure, Certification, Registration

• Certified Coding specialist (CCS) and/or Certified Procedural Coder (CPC)

Language Skills

• Strong written and verbal communication skills. 

Knowledge, Skills and Ability Requirements:

• Comprehensive understanding of ICD-10-CM diagnosis and ICD-10-PCS and/or CPT/HCPC.
• Understands the Uniform Hospital Discharge Data Set (UHDDS)
• Understands DRGs, APCs and/or Outpatient Code Edits (OCE) and Correct Coding Initiative (CCI) edits
• IRF-PAI (IP Rehabilitation)
• Working knowledge of clinical information
• Extensive knowledge of state, federal and Medicare regulations related to coding
• Basic knowledge of the revenue cycle for the purpose of communicating corrective action recommendations
• Microsoft Office Products; Word, Excel
• Encoder and/or Computer Assistant Coding (CAC)
• HROI and Cobius
• Strong analytical capabilities.
• Strong organizational skills.
• Strong critical thinking, problem solving and deductive reasoning skills.

Ability to:

• Function independently.
• Handle multiple priorities.
• Listen and acknowledge ideas and expressions of others attentively.
• Converses clearly using appropriate verbal and written communications as well as convey positive body language.
• Collaborate with others to achieve a common goal through mutual cooperation.
• Influence others for positive and productive outcomes.

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

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