Denials Specialist 2 / HIM Coding

Work where every moment matters. Every day, over 38,000 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: Responsible for the development and implementation of an effective HIM Coding denials program consistent with regulatory and healthcare revenue cycle industry standards. Demonstrates effective and efficient work operation of the unit and assigning work according to business needs and collecting data to monitor progress. Position Responsibilities: Key Areas of Responsibility Denials Resolution · Manages the HIM Coding Denial work queue and collaborates with coding managers and other departments as needed · Manages relationship with external denials vendor. Reviews audit findings and schedules quarterly meeting to provide updates on denial trends. · Conducts account research and works with others as needed to determine the appropriate course of denial appeals. · Maintains accurate, clear, timely documentation related to denied cases. · Manages denial database. Tabulates the financial gains of the position and opportunities for improvement. · Works with insurance companies as needed to resolve and appeal denials. · Proposes denial prevention workflows to achieve greater efficiency and facilitate maximum mitigation efforts · Creates written appeals utilizing official coding guidelines, coding clinic, and CPT assistant or other resources as appropriate. · Assists with processing HIM Coding validation denial and audit finding letters to third party vendor. · Monitors and follows up on appeals to ensure appeal has resulted in an overturned denial or has escalated through the proper channels. Denials Prevention · Tracks denial outcomes and write off reports, identifies trends. · Develops corrective action plans and works collaboratively with appropriate teams to prevent future denial. · Coordinates clinical appeals process and participates in compliance investigations as needed. Education · Identifies root causes and assists in developing and presenting education and process changes. · Works with and provides education to HHC staff on denials issues related to reimbursement, clinical criteria, insurance plan changes, regulations and process improvements. · Mentors new and existing team members on denials initiatives Leadership · Leads Coding denials · Contributes to the efficient operation of the denials unit by establishing priorities, eliminating obstacles, and resolving problems. · Evaluates denial performance and initiates corrective action plans as necessary Communication · Establishes collaborative relationships with HHC coding leadership to identify resolution of denial issues related to coding and documentation. · Escalates or communicates coding denials to appropriate departments per established process. (Coding, Billing, Compliance, etc.) · Serves as the resource for coding denial questions and issues from HIM Coding and other Revenue Cycle or clinical departments. Other · Runs reports and analyzes coding and denials data per requests from HIM coding teams as needed. · Participatesin the development and review of HIM Coding Policy and Procedures. · Participates in general or special assignments and other duties as assigned · 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 (Job Title):HIM Coding Quality Manager · Follows H3W Leadership Behaviors · Abides by HHC's Guiding Principles of Safety, Integrity, Caring and Excellence** · Fosters an environment of teamwork and service excellence for the team. ** · Leads and manages multiple concurrent projects, prioritizes tasks and adapts to frequent changes in priorities.** · Recognizes necessary changes in priority of tasks and allocation of resources, and brings them to the attention of leadership, as required.** Internal: · Strong working relationships with Coding Quality and Education, medical staff, HIM Coding staff, CDI, leadership teams and others as needed.** Education · Minimum:High school diploma · Preferred:Bachelor's degree or equivalent** Experience · Three or more years of progressive on-the-job coding experience in an acute care hospital setting. · Two years denials review, auditing, management, mentoring and/or coder training experience. Licensure, Certification, Registration · Registered Health Information Technician (RHIT), Registered Health Information Administratir (RHIA), Certified Coding specialist (CCS) and/or Certified Procedural Coder (CPC) Language Skills · Strong written and verbal communication skills. Knowledge, Skills and Ability Requirements: · Comprehensive understanding of ICD-10-CM diagnosis and ICD-10-PCS and/or CPT/HCPC. · Understands the Uniform Hospital Discharge Data Set (UHDDS) · Understands DRGs, APCs and/or Outpatient Code Edits (OCE) and Correct Coding Initiative (CCI) edits · IRF-PAI (IP Rehabilitation) · Working knowledge of clinical information · Extensive knowledge of state, federal and Medicare regulations related to coding · Knowledge of the revenue cycle for the purpose of communicating corrective action recommendations · Microsoft Office Products; Word, Excel · Encoder and/or Computer Assistant Coding (CAC) · Strong analytical capabilities. · Strong organizational skills. · Critical thinking, problem solving and deductive reasoning skills Ability to: · Function independently. · Handle multiple priorities. · Listen and acknowledge ideas and expressions of others attentively. · Converses clearly using appropriate verbal and written communications as well as convey positive body language. · Collaborate with others to achieve a common goal through mutual cooperation. · Influence others for positive and productive outcomes. 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. Job: *Medical Records / Health Information Organization: *Hartford HealthCare Corp. Title: Denials Specialist 2 / HIM Coding Location: Connecticut-Farmington-9 Farm Springs Rd Farmington (10566) Requisition ID: Other Locations: United States

Created: 2024-11-07