Invasive Coding Analyst - Ortho

Employment Status: Full‑time. Shift: Day (United States of America). Facility: 2331 Franklin Rd – Roanoke. Requisition Number: R159966. Position: Invasive Coding Analyst – Ortho. Job Summary The Invasive Coding Analyst identifies and analyzes denials, determines solutions, and implements corrections to result in accurate processing/payment of claims. Investigates denial and coding issues as they relate to services provided and associated charges. May require a strong working knowledge of multiple payers and their specific policies and procedures to serve as a subject matter expert. Makes important decisions and determinations by payers for claims. Works in a fast‑paced office environment with high productivity and accuracy standards that requires focus and concentration on tedious details and research. Key Responsibilities Identify and analyze denials, determine solutions, and implement corrections to result in accurate processing/payment of claims. Investigate denial and coding issues as they relate to services provided and associated charges. Maintain a strong working knowledge of multiple payers and their specific policies and procedures to serve as a subject matter expert. Make important decisions and determinations by payers for claims. Work in a fast‑paced office environment with high productivity and accuracy standards that requires focus and concentration on tedious details and research. Investigate and identify errors in billing, coding, or procedures relating to patient accounts. Collaborate with leadership to recommend solutions to management related to insurance issues, departmental procedures, and operations. Retrieve and analyze denial reports and provide recommendations based on findings. Act as a coding and billing expert and resource. Assist with denial reviews and create denial trending reports for management. Identify coding‑related revenue and reimbursement improvement opportunities for Orthopaedic Services and report findings to management. Consult with and provide education to physicians regarding clinical documentation as it relates to coding requirements. Conduct analysis of complex accounts. Determine actions and complete action steps to resolve accounts. Serve as a subject matter expert and provide guidance to RCM Specialists. Report erroneous processing trends by payer to management. Qualifications Education: High school education required. Experience: Minimum of 3 years of demonstrated proficiency in coding required. Licensure/Certification: RHIT, RHIA, CCA, CCS, CPC, or CPC‑H required. Effective oral and written communication skills. Must be a team player with initiative, organizational skills, analytical abilities, detail oriented, and have the ability to work independently. Maintain working knowledge of computer systems used for healthcare operations. Proficient with Word, Excel, and researching the web for coding and billing information. Must be able to provide own transportation for travel to other Carilion work sites. Benefits, Pay, and Well‑Being at Carilion Clinic Carilion understands the importance of prioritizing your well‑being to help you develop and thrive. That’s why we offer a well‑rounded benefits package and many perks and well‑being resources to help you live a happy, healthy life – at work and when you’re away. Comprehensive Medical, Dental, & Vision Benefits Employer Funded Pension Plan, vested after five years (Voluntary 403B) Paid Time Off (accrued from day one) Onsite fitness studios and discounts to our Carilion Wellness centers Access to our health and wellness app, Virgin Pulse Discounts on childcare Continued education and training Equal Opportunity Employer Carilion Clinic is an Equal Opportunity Employer: We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age (40 or older), disability, genetic information, or veterans status. Carilion is a Drug‑Free Workplace. This job description is only meant to be a representative summary of the major responsibilities and accountabilities performed by the incumbents of this job. The incumbents may be requested to perform job‑related tasks other than those stated in this description. #J-18808-Ljbffr