Inpatient Coding Denials Specialist

HCA Healthcare; Nashville (TN); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Comprehensive benefits package

401(k) Retirement plan with match

Tuition and certification support

Education and training programs

Job summary

HCA Healthcare is seeking an Inpatient Coding Denials Specialist to investigate and resolve payer denials, ensuring timely appeals and accurate DRG assignments. The role requires high-level coding expertise and strict adherence to applicable regulations.

The candidate will analyze documentation, write appeal letters, identify root causes of denials, and escalate issues for denial prevention and coding education opportunities. Strong productivity and accuracy are essential.

Qualifications

• Minimum 3 years of acute care hospital inpatient coding required.
• 5 years of inpatient coding experience preferred.
• Experience working payer denials and/or coding auditing preferred.
• RHIA, RHIT or CCS certifications preferred.

Responsibilities

• Analyzes documentation to support codes/DRGs and abstracted data for inpatient records using ICD-10-CM/PCS.
• Identifies and writes clear and concise appeal letters to defend billed claims.
• Escalates problem accounts/processes/trends to supervisor for denial prevention and coding education.
• Maintains or exceeds established productivity standards and accuracy standards.
• Reviews data quality standards, coding guidelines, and policies to stay current.

Skills

Inpatient coding

Coding denials analysis

Regulatory guidelines

Payer communication

Education

RHIA

RHIT

CCS

Tools

ICD-10-CM

ICD-10-PCS

Job description

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized.

Inpatient Coding Denials Specialist

Job Summary And Qualifications

The Inpatient Coding Denials Specialist is a high-level coding expert responsible for investigating and resolving coding related denials from payers, preventing lost reimbursement and promoting denial prevention. The Inpatient Coding Denials Specialist will adhere to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. The Inpatient Coding Denials Specialist must ensure timely, accurate, and thorough appeals for all accounts assigned and apply critical thinking skills to ascertain root cause of denials.

What you will do in this role:

• Analyzes documentation to support codes/DRGs and abstracted data (e.g., discharge disposition) for inpatient records for multiple facilities using ICD-10-CM and ICD-10-PCS to include:
• Principal diagnosis code assignment
• Secondary diagnosis code assignment
• Procedure code assignment
• Discharge disposition
• Identifies and writes clear and concise appeal letters utilizing all available documentation, regulations and guidelines to defend the billed claim
• Utilize the following resources to identify the root cause of the denial/downgrade
• Explanation of Benefits/Remittance Advice
• Payer denial/DRG downgrade letters
• Complex NCD/LCD guidelines, CMS/AHCA policies and regulations
• Federal Register, Center for Medicare and Medicaid Services, American Hospital Association, Food and Drug Administration, Medicare Administrative Contractors and payer websites
• Escalates problem accounts/processes/trends and report opportunities to supervisor for denial prevention and coding education opportunities
• Maintains or exceeds established productivity standards
• Maintains or exceeds established accuracy standards
• As needed, may periodically be asked to perform Coding Integrity Specialist III (CIS-III) or Coding Account Resolution Specialist III (CARS-III) duties
• Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current
• Follows all applicable coding guidance in assigning, sequencing, validation, and/or editing of codes/DRGs
• Meets all educational requirements as stated in current Company and HSC policy
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Other duties as assigned

Qualifications

• High School graduate or GED equivalent preferred, undergraduate (associate or bachelors) degree in HIM/HIT preferred.
• Minimum 3 year of acute care hospital inpatient coding required, 5 years preferred
• Experience working payer denials and/or coding auditing preferred
• RHIA, RHIT or CCS preferred

Benefits

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 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
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Note: Eligibility for benefits may vary by location.

Parallon

Parallon, provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.