Inpatient Coding Denials Specialist

HCA Healthcare•Nashville, TN

1d•Remote

About The Position

The Inpatient Coding Denials Specialist is a high-level coding expert who investigates and resolves payer denials related to coding, helps prevent lost reimbursement, and promotes denial prevention. The specialist ensures appeals for assigned accounts are timely, accurate, and thorough, and uses critical thinking to determine denial root causes. The role adheres to rules and regulations established by applicable local, state, and federal agencies and accrediting bodies. The position analyzes inpatient records for multiple facilities using ICD-10-CM and ICD-10-PCS, including principal and secondary diagnosis codes, procedure codes, and discharge disposition. It develops clear, concise appeal letters using available documentation, regulations, and guidelines to defend billed claims. The specialist reviews coding standards, policies, procedures, and clinical resources to keep coding knowledge current and follows applicable guidance when assigning, sequencing, validating, or editing codes and DRGs. The role is work from home. As needed, the specialist may periodically perform duties associated with Coding Integrity Specialist III or Coding Account Resolution Specialist III. Other duties may be assigned.

Requirements

Minimum of 3 years of acute care hospital inpatient coding experience.
High school graduate or GED equivalent preferred.
Undergraduate associate or bachelor's degree in HIM/HIT preferred.

Nice To Haves

Five years of acute care hospital inpatient coding experience preferred.
Experience working payer denials and/or coding auditing preferred.
RHIA, RHIT, or CCS credential preferred.
Associate or bachelor's degree in HIM/HIT preferred.

Responsibilities

Analyze inpatient documentation and abstracted data for multiple facilities using ICD-10-CM and ICD-10-PCS.
Assign principal diagnosis codes, secondary diagnosis codes, procedure codes, and discharge disposition.
Write clear and concise appeal letters using available documentation, regulations, and guidelines to defend billed claims.
Use explanation of benefits/remittance advice, payer denial or DRG downgrade letters, applicable guidelines and regulations, and other specified resources to identify denial root causes.
Escalate problem accounts, processes, and trends to a supervisor and report opportunities for denial prevention and coding education.
Maintain or exceed established productivity and accuracy standards.
Periodically perform Coding Integrity Specialist III or Coding Account Resolution Specialist III duties as needed.
Review data quality standards, coding guidelines, company policies and procedures, and clinical or medical resources to keep coding knowledge and skills current.
Follow applicable coding guidance for code and DRG assignment, sequencing, validation, and editing.
Meet educational requirements stated in current company and HSC policy.
Adhere to the Code of Conduct philosophy and Mission and Value Statement.
Perform other duties as assigned.

Benefits

Medical, prescription drug, dental, vision, behavioral health, and telemedicine coverage.
Wellbeing support, including free counseling and referral services.
Paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence.
401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.
Tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
Fertility and family-building benefits and adoption assistance.
Life insurance and supplemental health protection plans.
Auto and home insurance, legal counseling, identity theft protection, and consumer discounts.

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