Claims and Coding Denial Analyst

St. Luke’s University Health Network; Allentown (Lehigh County); On-site; USD 65,000 - 95,000; Full time

Job summary

St. Luke's University Health Network is seeking a certified medical coder with 2+ years of active E&M and/or surgical coding experience. Candidates should know ICD-10-CM, CPT and HCPCS coding and maintain up-to-date guidelines.

Primary duties include resolving coding denials, auditing documentation, and guiding providers. The role may offer remote or hybrid work after an on-site period, with flexible hours and collaborative teams. CPC required.

Qualifications

• CPC or CCA certification required.
• At least 2 years of active E&M and/or Surgical Coding experience.
• Must possess knowledge of ICD-10-CM, CPT and HCPCS coding.

Responsibilities

• Maintain current knowledge of coding, compliance, and documentation guidelines.
• Resolve Charge Review and Claim Edit edits for clean claim submission.
• Resolve coding denials through claim correction or appeal.
• Review supporting documentation and carrier policies for corrections.
• Collaborate with managers, physicians, and staff for appeals.
• Provide coding guidance to providers and staff for common errors.
• Track high-volume coding denial trends and report findings.
• Document root causes with spreadsheets and examples.
• Search governmental and payor guidelines to identify requirements.
• Review TCM encounters to verify required components.

Skills

CPC coding

EM coding

Surgical coding

Observing coding guidelines

Education

CPC certification

CCA certification

Tools

Epic Resolute

Job description

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

Hours, Location and Remote Work

HOURS: FT, 40 hours/week, Days Mon-Fri, days- hours flexible after training at manager's discretion Home location at St. Luke's Center, Allentown, PA with the opportunity for remote or hybrid remote work, available after at least 6 months on site, at manager's discretion, for local ( PA or NJ) candidates only. Obstetrics and Gynecology coding experience preferred. CPC required

Job Responsibilities

• Maintain current knowledge of coding, compliance, and documentation guidelines
• Resolve Charge Review and Claim Edit CCI/LCD edits, diagnosis coding errors and MUE frequency for clean claim submission
• Resolve coding denials through claim correction or appeal.
• Claim corrections will be made after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications.
• The appeals process may include collaboration with the Claim Editing Manager, Physician, Specialty Coder, AR specialist or Auditor/Educator.
• Demonstrate the ability to formulate an appeal rationale based on clinical documentation, application of LCD, relative carrier policy and published Academy or Societal guidance
• Provide coding guidance to providers and charge entry staff for single or low volume errors.
• Report high volume coding denial trends to the coordinator
• Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues.
• Performs searches of governmental, payor-specific, guidelines to identify and coding and billing requirements to make recommendations
• Review TCM Charge Review encounters to verify the documentation supports all required TCM components.
• Relevel TCM service when not supported by the documentation or TCM has been rendered during another TCM 30-day period
• Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations
• Assists with training new staff in all aspects of the Analyst role.

Physical and Sensory Requirements

Sitting for up to 8 hours per day, 3 hours at a time. Standing and walking as necessary. Fingering and handling frequently, twisting and turning of hands occasionally. Pushing and pulling. Occasionally stoops, bends, squats, kneels and reach above shoulder level. Hearing as it relates to normal conversation. Seeing as it relates to general and near vision.

Education and Training

CPC or CCA certification required. At least 2 years of active E&M and/or Surgical Coding experience required. Must possess a comprehensive knowledge of ICD-10-CM, CPT and HCPCS coding. Knowledge and experience in dealing with third party insurance companies relative to claim processing and coding denials follow up. Epic Resolute experience helpful

Equal Opportunity Statement

St. Luke’s University Health Network is an Equal Opportunity Employer.

Founded in 1872, St. Luke’s University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 23,000 employees providing services at 16 campuses and 350+ outpatient sites. With annual net revenue in excess of $4 billion, the Network’s service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke’s hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke’s Children’s Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare’s five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World’s Best Hospital. The Network’s flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Premier 13 times total and eleven years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY. In 2021, St. Luke’s was identified as one of the 15 Top Health Systems nationally. St. Luke’s is the ONLY health care institution in the Lehigh Valley to be named a Top Workplace regionally repeating the exclusive honor for the third year in a row. Also, for the third straight year, St. Luke’s has been a Top Workplaces in the Philadelphia Region by the Philadelphia Inquirer, ranking 9th in the large employer category for 2025 and the only health care system in PA to receive this award. In 2025, St. Luke’s was recognized as a national Top Workplaces by USA Today, three years in a row, including the 3rd best health care system in the nation in 2023 and 2024. Lastly, in 2025, St. Luke’s was named a Top Workplace in New Jersey for the third year in a row.

Learn More Here.