Work where every moment mattersEvery day over 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 Connecticutrsquos most comprehensive healthcare networkThe 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 organizationWith 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 systemPosition SummaryResponsible 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 progressPosition ResponsibilitiesKey Areas of ResponsibilityDenials Resolutionmiddot Manages the HIM Coding Denial work queue and collaborates with coding managers and other departments as neededmiddot Manages relationship with external denials vendor Reviews audit findings and schedules quarterly meeting to provide updates on denial trendsmiddot Conducts account research and works with others as needed to determine the appropriate course of denial appeals middot Maintains accurate clear timely documentation related to denied casesmiddot Manages denial database Tabulates the financial gains of the position and opportunities for improvement middot Works with insurance companies as needed to resolve and appeal denials middot Proposes denial prevention workflows to achieve greater efficiency and facilitate maximum mitigation effortsmiddot Creates written appeals utilizing official coding guidelines coding clinic and CPT assistant or other resources as appropriatemiddot Assists with processing HIM Coding validation denial and audit finding letters to third party vendormiddot Monitors and follows up on appeals to ensure appeal has resulted in an overturned denial or has escalated through the proper channels Denials Prevention middot Tracks denial outcomes and write off reports identifies trendsmiddot Develops corrective action plans and works collaboratively with appropriate teams to prevent future denialmiddot Coordinates clinical appeals process and participates in compliance investigations as neededEducationmiddot Identifies root causes and assists in developing and presenting education and process changesmiddot Works with and provides education to HHC staff on denials issues related to reimbursement clinical criteria insurance plan changes regulations and process improvementsmiddot Mentors new and existing team members on denials initiatives Leadershipmiddot Leads Coding denials middot Contributes to the efficient operation of the denials unit by establishing priorities eliminating obstacles and resolving problemsmiddot Evaluates denial performance and initiates corrective action plans as necessaryCommunicationmiddot Establishes collaborative relationships with HHC coding leadership to identify resolution of denial issues related to coding and documentationmiddot Escalates or communicates coding denials to appropriate departments per established process Coding Billing Compliance etcmiddot Serves as the resource for coding denial questions and issues from HIM Coding and other Revenue Cycle or clinical departmentsOthermiddot Runs reports and analyzes coding and denials data per requests from HIM coding teams as neededmiddot Participates in the development and review of HIM Coding Policy and Proceduresmiddot Participates in general or special assignments and other duties as assigned middot Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelinesWorking RelationshipsThis Job Reports To Job Title HIM Coding Quality Managermiddot Follows HW Leadership Behaviorsmiddot Abides by HHCrsquos Guiding Principles of Safety Integrity Caring and Excellencemiddot Fosters an environment of teamwork and service excellence for the team middot Leads and manages multiple concurrent projects prioritizes tasks and adapts to frequent changes in priorities middot Recognizes necessary changes in priority of tasks and allocation of resources and brings them to the attention of leadership as required Internalmiddot Strong working relationships with Coding Quality and Education medical staff HIM Coding staff CDI leadership teams and others as neededWork where every moment mattersEvery day over 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 Connecticutrsquos most comprehensive healthcare networkThe 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 organizationWith 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 systemPosition SummaryResponsible 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 progressPosition ResponsibilitiesKey Areas of ResponsibilityDenials Resolutionmiddot Manages the HIM Coding Denial work queue and collaborates with coding managers and other departments as neededmiddot Manages relationship with external denials vendor Reviews audit findings and schedules quarterly meeting to provide updates on denial trendsmiddot Conducts account research and works with others as needed to determine the appropriate course of denial appeals middot Maintains accurate clear timely documentation related to denied casesmiddot Manages denial database Tabulates the financial gains of the position and opportunities for improvement middot Works with insurance companies as needed to resolve and appeal denials middot Proposes denial prevention workflows to achieve greater efficiency and facilitate maximum mitigation effortsmiddot Creates written appeals utilizing official coding guidelines coding clinic and CPT assistant or other resources as appropriatemiddot Assists with processing HIM Coding validation denial and audit finding letters to third party vendormiddot Monitors and follows up on appeals to ensure appeal has resulted in an overturned denial or has escalated through the proper channels Denials Prevention middot Tracks denial outcomes and write off reports identifies trendsmiddot Develops corrective action plans and works collaboratively with appropriate teams to prevent future denialmiddot Coordinates clinical appeals process and participates in compliance investigations as neededEducationmiddot Identifies root causes and assists in developing and presenting education and process changesmiddot Works with and provides education to HHC staff on denials issues related to reimbursement clinical criteria insurance plan changes regulations and process improvementsmiddot Mentors new and existing team members on denials initiatives Leadershipmiddot Leads Coding denials middot Contributes to the efficient operation of the denials unit by establishing priorities eliminating obstacles and resolving problemsmiddot Evaluates denial performance and initiates corrective action plans as necessaryCommunicationmiddot Establishes collaborative relationships with HHC coding leadership to identify resolution of denial issues related to coding and documentationmiddot Escalates or communicates coding denials to appropriate departments per established process Coding Billing Compliance etcmiddot Serves as the resource for coding denial questions and issues from HIM Coding and other Revenue Cycle or clinical departmentsOthermiddot Runs reports and analyzes coding and denials data per requests from HIM coding teams as neededmiddot Participates in the development and review of HIM Coding Policy and Proceduresmiddot Participates in general or special assignments and other duties as assigned middot Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelinesWorking RelationshipsThis Job Reports To Job Title HIM Coding Quality Managermiddot Follows HW Leadership Behaviorsmiddot Abides by HHCrsquos Guiding Principles of Safety Integrity Caring and Excellencemiddot Fosters an environment of teamwork and service excellence for the team middot Leads and manages multiple concurrent projects prioritizes tasks and adapts to frequent changes in priorities middot Recognizes necessary changes in priority of tasks and allocation of resources and brings them to the attention of leadership as required Internalmiddot Strong working relationships with Coding Quality and Education medical staff HIM Coding staff CDI leadership teams and others as neededEducationmiddot Minimum High school diplomamiddot Preferred Bachelorrsquos degree or equivalent Experiencemiddot Three or more years of progressive on the job coding experience in an acute care hospital settingmiddot Two years denials review auditing management mentoring andor coder training experienceLicensure Certification Registrationmiddot Registered Health Information Technician RHIT Registered Health Information Administratir RHIA Certified Coding specialist CCS andor Certified Procedural Coder CPCLanguage Skillsmiddot Strong written and verbal communication skills Knowledge Skills and Ability Requirementsmiddot Comprehensive understanding of ICD CM diagnosis and ICD PCS andor CPTHCPCmiddot Understands the Uniform Hospital Discharge Data Set UHDDSmiddot Understands DRGs APCs andor Outpatient Code Edits OCE and Correct Coding Initiative CCI edits middot IRF PAI IP Rehabilitationmiddot Working knowledge of clinical information middot Extensive knowledge of state federal and Medicare regulations related to codingmiddot Knowledge of the revenue cycle for the purpose of communicating corrective action recommendationsmiddot Microsoft Office Products Word Excelmiddot Encoder andor Computer Assistant Coding CACmiddot Strong analytical capabilitiesmiddot Strong organizational skillsmiddot Critical thinking problem solving and deductive reasoning skillsAbility tomiddot Function independentlymiddot Handle multiple prioritiesmiddot Listen and acknowledge ideas and expressions of others attentivelymiddot Converses clearly using appropriate verbal and written communications as well as convey positive body languagemiddot Collaborate with others to achieve a common goal through mutual cooperation middot Influence others for positive and productive outcomesWe take great care of careersWith 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 ndash 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 worklife balance Every moment matters And this isyour momentEducationmiddot Minimum High school diplomamiddot Preferred Bachelorrsquos degree or equivalent Experiencemiddot Three or more years of progressive on the job coding experience in an acute care hospital settingmiddot Two years denials review auditing management mentoring andor coder training experienceLicensure Certification Registrationmiddot Registered Health Information Technician RHIT Registered Health Information Administratir RHIA Certified Coding specialist CCS andor Certified Procedural Coder CPCLanguage Skillsmiddot Strong written and verbal communication skills Knowledge Skills and Ability Requirementsmiddot Comprehensive understanding of ICD CM diagnosis and ICD PCS andor CPTHCPCmiddot Understands the Uniform Hospital Discharge Data Set UHDDSmiddot Understands DRGs APCs andor Outpatient Code Edits OCE and Correct Coding Initiative CCI edits middot IRF PAI IP Rehabilitationmiddot Working knowledge of clinical information middot Extensive knowledge of state federal and Medicare regulations related to codingmiddot Knowledge of the revenue cycle for the purpose of communicating corrective action recommendationsmiddot Microsoft Office Products Word Excelmiddot Encoder andor Computer Assistant Coding CACmiddot Strong analytical capabilitiesmiddot Strong organizational skillsmiddot Critical thinking problem solving and deductive reasoning skillsAbility tomiddot Function independentlymiddot Handle multiple prioritiesmiddot Listen and acknowledge ideas and expressions of others attentivelymiddot Converses clearly using appropriate verbal and written communications as well as convey positive body languagemiddot Collaborate with others to achieve a common goal through mutual cooperation middot Influence others for positive and productive outcomesWe take great care of careersWith 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 ndash 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 worklife balance Every moment matters And this isyour moment