HB Inpatient Denials Integrity Specialist

Advocate Health Care; Oak Brook (IL); Hybrid; USD 46,000 - 68,000; Full time

Benefits offered by this job

Health benefits

Paid time off

Retirement plan

Educational assistance

Job summary

Advocate Health Care in Illinois seeks an experienced inpatient/denials coder to analyze and resolve PB/HB denials using CPT, HCPCS, and ICD-10-CM. The role requires audit experience, chart reviews, and collaboration with billing and payer teams to prevent future denials.

Ideal candidates will have AHIMA or AAPC certification and at least four years of hospital-based coding experience, with strong attention to detail and knowledge of reimbursement policies.

Qualifications

• Associate degree or equivalent education required.
• AHIMA or AAPC certification required.
• 4 years of expert-level hospital-based coding experience.
• Experience with revenue cycle processes and medical record auditing.

Responsibilities

• Analyze and resolve coding-related PB and HB denials using CPT, HCPCS, ICD-10-CM, and modifiers.
• Identify root causes and trends in denial and rejection codes.
• Collaborate with billing, coding, and payer teams to correct, resubmit, and prevent denied claims.
• Conduct chart reviews to validate documentation against billed services.
• Prepare and support appeals by researching payer guidelines and coding standards.

Skills

Analytical thinking

Team collaboration

Attention to detail

Education

Associate degree or equivalent

AHIMA or AAPC certification

Tools

CPT

HCPCS

ICD-10-CM

Denials analysis

Job description

Position Details

Department: 13246 Enterprise Revenue Cycle - Integrity Operations: Facility Coding Denials
Status: Full time
Benefits Eligible: Yes
Hours Per Week: 40
Schedule Details/Additional Information: First Shift Hospital Based INPATIENT Coding Experience Required. Denials related experience preferred May work remote for this opportunity out of the following states: AL, AK, AR, AZ, DE, FL, GA, IA, IL, ID, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.

Pay Range

Pay Range: $33.05 - $49.60

Major Responsibilities

Analyze and resolve coding-related PB and HB denials using CPT, HCPCS, ICD-10-CM, and modifiers. Identify root causes, patterns, and trends in denial and rejection codes. Collaborate with billing, coding, and payer teams to correct, resubmit, and prevent denied claims. Conduct chart reviews to validate documentation against billed services. Prepare and support appeals by researching payer guidelines, coding standards, and coverage policies. Ensure accurate, compliant coding and sequencing aligned with official guidelines and payer requirements. Track, document, and report denial resolutions, appeal outcomes, and coding quality issues. Support compliance, quality assurance, and revenue integrity initiatives through issue monitoring and escalation resolution. Educate clinicians, coders, and staff by sharing findings and supporting targeted training based on denial trends. Contribute to operational and strategic initiatives, including denial avoidance strategies, work queue optimization, CARC code mapping, and technology-driven improvements.

Minimum Job Requirements

Education Associate degree or equivalent education and experience required. Certification / Registration / License Coding credential required. A Coding Certification from American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) with relevant experience. Experience 4 years of experience in expert-level hospital-based coding and experience in revenue cycle processes, health information workflows, and medical record auditing experience.

Knowledge / Skills / Abilities

Advanced knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage decisions, research related restrictions, and ICD-10-PCS/CM, CPT, and HCPCS coding classification systems. Advanced knowledge of medical terminology, anatomy, and physiology. Advanced ability to identify coding discrepancies and provide recommendations for improvement Advanced ability to analyze trends and data and display them in a statistical reporting format. Advanced knowledge of care delivery documentation systems and related medical record documents. Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines. Advanced knowledge of Microsoft Office, video and web conferencing, email, and experience with electronic coding and EHR systems or applications. Advanced interpersonal and communication (oral and written) skills, including the ability to effectively collaborate with multiple departments. Advanced organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment. Advanced analytical skills, with great attention to detail. Self-motivated with initiative and strong sense of ethics. Ability to work independently and exercise independent judgment and decision making. Ability to meet deadlines while working in a fast-paced environment. Strong organizational skills and ability to work independently with limited guidance or direction. Effective critical thinking, creativity, problem solving and decision-making skills.

Physical Requirements and Working Conditions

Position requires travel which will result in exposure to road and weather hazards. Operates the equipment necessary to perform the job. Exposed to a normal office environment.

Preferred Job Requirements

Preferred Certification / Registration / License Second Specialty credential preferred.

Our Commitment to You

• Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance
• Benefits and more
• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. This is Transformation One shared purpose brought us together. Now, as one of the 10 largest not-for-profit, integrated health systems in the United States, our combined strength and stability drives us forward. Starting with You Caring for nearly 3 million people has inspired a transformation. One in which the patient’s experience guides our vision and empowers us to offer new possibilities in our communities. Reshaping Access What is access? It’s offering more sites of care than any other health system in the Midwest. But there’s a new frontier. Access is exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we’ll touch more lives and contribute to stronger and more vibrant communities. Transforming Care We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in: Cardiovascular Care Neurosciences Gynecology Oncology Pediatrics Primary Care Neurology Geriatrics Trauma Care.