Hartford HealthCare · 1 month ago
Denial RN DRG Appeal Writer1 / HIM Coding
Farmington, CT
Full-time
Onsite
Entry, Mid Level
2+ years expHartford HealthCare is Connecticut’s most comprehensive healthcare network, and they are seeking a Denial Specialist responsible for reviewing, analyzing, and appealing denials related to DRG downgrades. This role involves validating coding and clinical accuracy, ensuring proper documentation, and collaborating with other departments to address payer concerns.
Health CareHealth DiagnosticsHospitalOncologyPharmaceuticalRehabilitation
Responsibilities
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
Analyze denial patterns to identify root causes and collaborate on preventive strategies
Proactively address discrepancies between payer policies, regulatory standards and internal processes to prevent future denials
Develop and implement process improvements aimed at preventing denials, such as better workflows, enhanced communication between departments, or technology solutions
Provide regular reports and feedback to leadership and relevant departments on denial prevention efforts, identifying areas needing attention
Provide ongoing education to the coding and CDI teams regarding DRG validation, payer guidelines, and best practices to minimize future denials
Collaborate with Revenue Cycle and Medical Staff teams to ensure a unified approach to denial management and appeals
Serve as the primary contact with payers on DRG-related denials. Effectively communicate the clinical and coding rationale for the DRG assignment and challenge inappropriate denials
Respond to department inquiries regarding claim denials, explaining the resolution process and providing updates as needed
Communicates across departments as needed
Performs other related duties as required
Mentors new and existing team members
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines
Qualification
Required
Associate of Science in Nursing
Two (2) years of progressive on-the-job inpatient and/or clinical documentation experience within healthcare revenue cycle or other healthcare field
Active Registered Nurse license from the State of Connecticut
Certified Clinical Documentation Specialist (CCDS)
Certified Documentation Integrity Practitioner (CDIP)
Strong written and verbal communication skills
Strong understanding of ICD-10-CM/PCS coding, DRG assignment, and payer regulations related to DRG validation
Ability to analyze medical records, coding documentation, and payer denial reasons to determine appropriate appeal strategies
Excellent written and verbal communication skills, with the ability to clearly articulate clinical and coding justifications in appeal letters
Ability to manage multiple denials, prioritize tasks, and ensure timely submission of appeals
Experience with electronic health record (EHR) systems, coding software, and denial tracking tools
Proficient in tracking systems and data management tools
Strong organizational skills with a high level of accuracy and attention to detail
Strong interpersonal skills
Excellent communication and collaboration abilities
Strong problem-solving, analytical, and critical thinking skills
Experience working with cross-functional departments to research and resolve issues using innovative solutions
Ability to work independently
Ability to provide outstanding customer service
Preferred
Bachelor of Science in Nursing
Three (3) years of progressive on-the-job experience with DRG denial management and appeals preferred
Benefits
Competitive benefits program designed to ensure work/life balance
Company
Hartford HealthCare
Hartford HealthCare is a group of hospitals that offers complete healthcare services including cancer care, rehabilitation and pharmacy.
10001+ employees
H1B Sponsorship
Hartford HealthCare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (9)
2024 (2)
2023 (4)
2022 (6)
2021 (4)
2020 (8)
Funding
Current Stage
Late StageTotal Funding
$150MKey Investors
Connecticut Health and Educational Facilities Authority
2024-04-01Debt Financing· $150M
Leadership Team
Jeffrey Flaks
President & Chief Executive Officer, Hartford HealthCare
Bimal Patel
Executive Vice President/ Chief Operating Officer
Recent News
Hartford Business Journal
2025-12-18
Company data provided by crunchbase