Inpatient Denials Integrity Specialist
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Job Description
Inpatient Denials Integrity Specialist responsible for analyzing coding-related hospital claims and resolving denials. Collaborating with billing and coding teams, supporting appeals, and ensuring compliance.
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.
Requirements:
- Associate degree or equivalent education and experience required.
- Coding credential required.
- A Coding Certification from American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) with relevant 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.
- 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.
Benefits:
- 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
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