HB Inpatient Denials Integrity Specialist
Department:
13246 Enterprise Revenue Cycle - Integrity Operations: Facility Coding Denials Status:
Full time Benefits Eligible:
Yes Hou rs 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:
$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 t