Denial RN DRG Appeal Writer2 / HIM Coding

Hartford Healthcare•Farmington, CT

About The Position

Work where every moment matters. Every day, more than 40,000 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. Position Summary: The level 2 Denial Specialist Appeal Writer reviews and analyzes Diagnostic Related Grouper (DRG) downgrades, preparing detailed, evidence-based appeal letters to defend assigned DRGs and optimize reimbursement. This role requires interpreting medical records, applying official coding guidelines, reviewing payer contracts and exercising clinical judgment. The specialist also helps prevent future downgrades by identifying trends and providing feedback to enhance coding accuracy and clinical documentation. Provide ongoing education to HHC Institute leaders, providers, coding and CDI teams on DRG validation, documentation best practices, payer guidelines and best practices to minimize future denials.

Requirements

Bachelor of Science in Nursing
Four (4) years of progressive on-the-job inpatient and/or clinical documentation experience within healthcare revenue cycle or other healthcare field.
Active Registered Nurse license from the State of Connecticut
Strong written and verbal communication skills.
Strong knowledge of ICD-10-CM/PCS coding, DRG assignment and MS-DRG/APR-DRG systems.
Excellent written communication skills, with the ability to translate complex clinical and coding concepts into persuasive arguments.
Proficient with tracking systems, data management tools, and payer contract requirements, including appeal timelines and regulations.
Attention to detail, analytical thinking and the ability to meet deadlines in a fast-paced environment.
Strong organizational, interpersonal, communication and collaboration skills.
Experienced in cross-functional teamwork to research and resolve issues using innovative solutions.
Strong problem-solving and critical thinking abilities; able to work independently while delivering outstanding customer service.

Nice To Haves

Master’s degree or equivalent
Six (6) years of progressive on-the-job experience with DRG denial management and appeals preferred.
Certified Clinical Documentation Specialist (CCDS), Certified Documentation Integrity Practitioner (CDIP)

Responsibilities

Provide ongoing education to HHC Institute leaders, providers, coding and CDI teams on DRG validation, documentation best practices, payer guidelines and best practices to minimize future denials.
Review payer DRG downgrade denials to assess validity and potential for appeal.
Analyze medical records, coding and clinical documentation to support the billed DRG using ICD-10-CM/PCS guidelines, UHDDS definitions, Coding Clinic, and regulatory requirements.
Prepare and submit persuasive appeal letters that include a patient summary, evidence-based criteria, coding references and citations from authoritative sources.
Maintain accurate appeal records in designated systems, track statuses and meet payer-specific submission deadlines.
Lead trend analysis to identify denial patterns and recommend process improvements.
Achieve departmental KPIs related to turnaround times, appeal success rates and denial reduction targets.
Collaborates with CDI provider leads at each facility to enhance denial proof documentation.
Stay current with payer policies, regulatory changes, coding guidelines and industry best practices to support revenue protection efforts.
Collaborate with Coding, CDI and physicians to clarify documentation and ensure accurate DRG assignment.
Serve as primary contact with payers for DRG-related denials, clearly communicating clinical and coding rationale.
Provide timely updates and feedback to leadership and departments on denial prevention efforts and appeal outcomes.
Performs other related duties as required.
Mentors new and existing team members.
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.