PB RI Denials Spec / PB Coding

Hartford HealthCare; Farmington (CT); On-site; USD 55,000 - 85,000; Full time

Job summary

Hartford HealthCare is seeking a Revenue Integrity Denials Specialist to review and resolve coding denials and patient account issues. You will research denials, verify documentation, and ensure accurate ICD-10-CM and CPT/HCPCS coding within Epic.

The role requires CPC/CCS-P certification and 3–5 years in denial management or healthcare experience, with strong communication and time-management skills.

Qualifications

• Associate’s degree or equivalent work experience.
• 3-5 years of experience with professional Coding denial/avoidable write-off (or healthcare experience).
• CPC, CCS-P certification required and maintained thereafter.
• Strong written and verbal communication skills.
• Strong knowledge of coding concepts.
• ICD-10-CM diagnostic and CPT/HCPCS procedure codes & modifiers.
• Clinical information related to areas of responsibility.
• Knowledge of insurance claim processing and EOB/remittance codes.

Responsibilities

• Review and research coding denials and customer service complaints to bring to resolution.
• Review medical records for reconsideration purposes.
• Assign appropriate ICD-10-CM, CPT/HCPCS codes, modifiers and E/M codes as required.
• Document all account activity in Epic.
• Meet revenue cycle KPIs and productivity standards.
• Assist manager with training new colleagues.

Skills

Coding concepts

Medical necessity understanding

Problem-solving

Time management

Communication

Education

Associate’s degree or equivalent work experience

Tools

Encoder

Excel

Job description

Location Detail: 9 Farm Springs Rd Farmington (10566)

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 PB Revenue Integrity Denials Specialist is responsible for review and research of professional coding denials and identification of root causes for resolution to improve timely revenue recovery. Utilizes expert problem-solving skills to resolve complex billing issues, unpaid claims and customer complaints, taking all steps and coordinating corrective action to ensure full resolution of prompt payment.

Position Responsibilities

Key Areas of Responsibility

Denials

• Work key workques related to Coding denials and Customer Service Complaints
• Review and research Customer Service Coding Complaints and bring to resolution
• Review and research coding denials related to medical necessity, Coding and identify root causes for resolution
• Review Medical records for reconsideration purposes
• Evaluates denials against medical record documentation, the coding of the encounter, payer policies to determine if coding corrections are needed or the denial can be appealed
• Analyzes medical records, interprets documentation and assigns proper International Classification of Diseases, Tenth Edition Clinical Modification (ICD‑10‑CM), Current Procedural Terminology/HealthCare Common Procedure Coding System (CPT/HCPCS), modifiers, and Evaluation & Management codes utilizing designated software encoder, coding manuals and other reference material as required.
• Demonstrates in-depth understanding of Medicare, Medicaid and private payors, policies and guidelines
• Researches and resolves denials making appropriate decisions on accounts to optimize reimbursement
• Accurately document all account activity in Epic.
• Adheres to all department coding/charging procedures, policies, guidelines and quality standards.
• Assists manager with special projects/other tasks as assigned
• Abides by the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adheres to official coding guidelines.
• Meets revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards).
• Proactively identifies opportunities for revenue cycle improvement initiatives to prevent future denials/Avoidable Write offs (AWOs) and improve timely revenue recovery. Collaborate with leadership and other key stakeholders to make solution recommendations. Examples include but not limited to Education for clinicians and or coders or new EPIC edits to prevent denials.
• Maintains appropriate Standard Work documentation related to denials & customer service work
• As assigned, assists in training new colleagues to become acclimated to the environment and in understanding internal policies and procedures, and documentation guidelines.

Qualifications

Education

• Associate’s degree or equivalent work experience

Experience

• 3-5 years of experience with professional Coding denial/avoidable write-off (or healthcare experience)

Licensure, Certification, Registration

• CPC, CCS-P certification required and maintained thereafter

Language Skills

• Strong written and verbal communication skills.

Knowledge, Skills And Ability Requirements

• Strong knowledge of coding concepts
• ICD‑10-CM diagnostic and CPT/HCPCS procedure codes & Modifiers
• Clinical information related to areas of responsibility
• Microsoft Office Products; Word, Excel
• Encoder
• Knowledge and understanding of insurance claim processing and third-party reimbursement.
• Knowledge and understanding of insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes
• Knowledge of healthcare related financial and/or accounting practices.
• Skill in effective oral, written, and interpersonal communication.
• Skill in problem-solving in a variety of settings and translation of data into actionable steps.
• Skill in time management
• Ability to prioritize and elevate issues.
• Ability to work comfortably with revenue cycle leadership, practice personnel and providers across the Hartford HealthCare System
• Ability to work with a variety of stakeholders at multiple organizational levels
• Ability to read, understand and interpret, analyze, and apply complex regulatory requirements.
• Ability to operate a computer and related applications.
• Ability to work independently and take initiative.
• Ability to handle multiple priorities

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.