Denial Coordinator / HIM Coding

Denial Coordinator

Work where every moment matters. Every day, over 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 Connecticuts 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 Denial Coordinator will serve as the central person for processing all Diagnostic Reimbursement Group (DRG) validation denials. This position is responsible for ensuring the timely and accurate processing of DRG validation denials, managing documentation, tracking information requests and ensuring adherence to appeal deadlines. The Denial Coordinator will also work in collaboration with the HIM Audit Coordinator.

Position Responsibilities:

Key Areas of Responsibility

• Coordinate, initiate and respond to all DRG denial requests through resolution.
• Monitor and maintain status of all appeal levels, ensuring timely follow-up and closure.
• Track denial activity and appeal outcomes to identify trends and opportunities for improvement.
• Conduct account research and determine appropriate appeal strategies, escalating as needed.
• Collaborate with coding, CDI, physicians and other stakeholders to investigate and resolve denials.
• Ensure compliance with payer deadlines, appeal timelines and contract terms.
• Enter and maintain accurate denial and appeal data in the designated tracking system.
• Prepare and distribute reports on denial activity and appeal outcomes to inform stakeholders.
• Run ad hoc reports and analyze DRG validation denial trends as requested.
• Creates written appeals utilizing official coding guidelines, coding clinic, and CPT assistant or other resources as appropriate.

Communication

• Serve as liaison between the organization, payers and vendors to resolve claims and clarify guidelines.
• Communicate effectively across departments to support appeal efforts and obtain documentation.
• Support denials management team with delegated tasks and maintenance of documentation tools.

Other

• Evaluate and improve denial management processes in response to audit findings or operational needs.
• Assist teams in developing tools and workflows to reduce denials and improve appeal outcomes.
• Ensure adherence to revenue cycle KPIs and productivity standards.
• Maintain compliance with AHIMAs Standards of Ethical Coding and official coding guidelines.
• Mentor new and current team members.
• Perform other related duties as assigned.

Working Relationships: This Job Reports To (Job Title): Medical Director

Qualifications

Requirements and Specifications:

Education

• Associate degree or equivalent

Experience

• Minimum two (2) years' experience within healthcare revenue cycle or other healthcare field performing a variety of organizational, administrative, or process improvement functions
• Preferred three (3) years of progressive on-the-job DRG denials experience within healthcare revenue cycle or other healthcare field performing DRG denial review, auditing, or Clinical Documentation reviews.

Licensure, Certification, Registration

• A Certified Professional Coder with a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), and/or Certified Procedural Coder (CPC), Homecare Coding Specialist HCS-D or HCS-O

Language Skills

• Strong written and verbal communication skills

Knowledge, Skills and Ability Requirements:

• Comprehensive understanding of ICD-10-CM diagnosis and ICD-10-PCS
• Familiarity with payer guidelines, healthcare billing codes, and medical terminology
• Strong organizational skills with a high level of accuracy and attention to detail
• Strong interpersonal skills
• Excellent communication and collaboration abilities
• Strong problem-solving, analytical, and critical thinking skills
• Strong presentation skills with the ability to feel comfortable in presenting/defending audit logic to client and key stakeholders
• Experience working with cross-functional departments to research and resolve issues using innovative solutions
• Proficient with spreadsheets and database applications