HB Inpatient Denials Integrity Specialist

Job : R241337

Shift: Days

Pay range: $33.05 – $49.60 per hour

Location:

Remote, US

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

• Base compensation within the position’s pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate’s job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

• 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

Note:

Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc); please ask a Recruiter for more information during an interview.

• 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, , 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.

• 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.

• Diploma 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…