Denial RN DRG Appeal Writer2 / HIM Coding

Hartford HealthCare; Farmington (CT); On-site; USD 85,000 - 115,000; Full time

Job summary

Hartford HealthCare in Connecticut seeks a Level 2 Denial Specialist Appeal Writer to review DRG downgrades, interpret medical records per ICD-10-CM/PCS guidelines, and craft persuasive appeal letters to optimize reimbursement.

You will educate CDI teams and department leaders on denial prevention, work with payers to resolve issues, and monitor trends to reduce future denials while ensuring regulatory compliance.

Qualifications

• Bachelor of Science in Nursing required.
• Active RN license in CT required.
• CCDS and CDIP certifications preferred.
• Minimum 4 years inpatient/clinical documentation experience.

Responsibilities

• Provide ongoing education to CDI teams and leaders on DRG validation and documentation best practices.
• Review payer DRG downgrade denials for validity and appeal potential.
• Analyze medical records and coding to support billed DRG per ICD-10-CM/PCS guidelines.
• Prepare persuasive appeal letters with patient summaries and citations.
• Maintain appeal records and track submission deadlines.
• Lead trend analysis to identify denial patterns and suggest improvements.
• Meet departmental KPIs for turnaround times and appeal success.

Skills

ICD-10-CM/PCS coding knowledge

Analytical thinking

Strong written communication

Cross-functional collaboration

Attention to detail

Education

Bachelor of Science in Nursing

Master’s degree or equivalent

Tools

Coding software systems

Job description

Location

9 Farm Springs Rd Farmington (10566)

About this role

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.

Position Responsibilities

Key Areas of Responsibility

• 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.

Education

• 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.


• 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.

Communication

• 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.

Other Responsibilities

• 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.

Working Relationships

This Job Reports To: Medical Director

Qualifications

Requirements and Specifications

Education

Minimum: Bachelor of Science in Nursing

• Preferred: Master’s degree or equivalent

Experience

• Minimum: Four (4) years of progressive on-the-job inpatient and/or clinical documentation experience within healthcare revenue cycle or other healthcare field.


• Preferred: Six (6) years of progressive on-the-job experience with DRG denial management and appeals preferred.

Licensure, Certification, Registration

• Active Registered Nurse license from the State of Connecticut


• Certified Clinical Documentation Specialist (CCDS), Certified Documentation Integrity Practitioner (CDIP)

Language Skills

• Strong written and verbal communication skills.

Knowledge, Skills And Ability Requirements

• 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.

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.