Denial RN DRG Appeal Writer1 / HIM Coding

Location Detail : 9 Farm Springs Rd Farmington (10566)

W ork 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 Denial Specialist is responsible for reviewing, analyzing and appealing denials related to DRG (Diagnostic Related Group) downgrades. This role involves validating the coding and clinical accuracy, ensuring proper documentation and collaborating with other departments to address payer concerns. Key responsibilities include timely investigation of DRG downgrades, submitting appeals, coordinating follow-up actions and ensuring compliance with regulatory standards. The specialist also plays a critical role in preventing future downgrades by identifying trends and providing feedback to improve coding and clinical documentation practices.

Position Responsibilities :

Key Areas of Responsibility

Denial Resolution

• Conduct a thorough review of medical records, coding and clinical documentation to validate or appeal payer denials.
• Prepare, document and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding guidelines, and regulatory requirements.
• Work closely with the Clinical Documentation Improvement (CDI) and Coding teams to ensure accurate DRG assignment and enhance documentation practices that support appropriate reimbursement.
• Ensure that all DRG denial and appeal activities comply with federal, state, and payer-specific regulations, including maintaining knowledge of ICD-10-CM / PCS coding guidelines and CMS regulations.
• Maintain accurate records of denial appeals in the designated software, including the status of appeals, timelines, and outcomes.
• Monitor appeal deadlines to ensure timely submission of all required documentation and compliance with payer appeal windows.
• Contribute to revenue protection efforts by successfully overturning inappropriate denials and reducing the financial impact of DRG downgrades.
• Meet departmental performance goals, including Key Performance Indicators (KPIs) related to denial turnaround times, appeal success rates, and denial reduction targets.

Denials Prevention

Education

Stays current on payer policies, regulatory changes, coding guidelines (e.g., ICD-10, DRG), and healthcare regulations that could impact denials and coding practices.

Communication

Other

Working Relationships :

This Job Reports To :   Medical Director

Qualifications

Requirements and Specifications :

Education

Experience

Licensure, Certification, Registration

Language Skills

Knowledge, Skills and Ability Requirements

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.