Invasive Coding Analyst - Ortho

CP01 Carilion Medical Center; Virginia (MN); On-site; USD 31,684 - 45,460; Full time

Benefits offered by this job

Medical benefits

Pension

Paid time off

Onsite fitness facilities

Wellbeing app access

Childcare discounts

Education and training

Job summary

Carilion Clinic seeks an Invasive Coding Analyst - Ortho to analyze denials, ensure accurate claim processing, and provide expert coding guidance across payers. You will investigate coding issues, educate physicians on documentation requirements, and support RCM Specialists with denial reviews.

The role requires 3+ years coding proficiency, RHIT/RHIA/CCA/ CCS or CPC-Certification, and strong communication skills. Onsite in Roanoke with competitive compensation and benefits.

Qualifications

• Minimum 3 years of demonstrated proficiency in coding.
• RHIT, RHIA, CCA, CCS, CPC, or CPC-H certification required.
• High school education required.
• Effective oral and written communication skills; team player with initiative, organizational skills, analytical abilities, detail oriented; able to work independently.

Responsibilities

• Identify and analyze denials, determine solutions and implement corrections to ensure accurate processing/payments of claims.
• Investigate denial and coding issues related to services provided and associated charges.
• Serve as subject matter expert on payer policies and procedures across multiple payers.
• Make important decisions and determinations regarding claims for payers.
• Identify errors in billing, coding, or procedures related to patient accounts.
• Retrieve and analyze denial reports and provide recommendations based on findings.
• Act as coding and billing expert and resource for RCM Specialists.
• Assist with denial reviews and create denial trending reports for management.
• Identify coding‑related revenue and reimbursement improvement opportunities for Orthopedic Services and report findings to management.
• Consult with physicians to provide education on clinical documentation relative to coding requirements.
• Conduct analysis of complex accounts and determine action steps to resolve accounts.
• Provide guidance to RCM Specialists, serving as a subject‑matter expert.
• Collaborate with Orthopedic Leadership to recommend solutions concerning insurance issues, departmental procedures, and operations.
• Report erroneous processing trends by payer to management.

Skills

Coding proficiency

Communication skills

Analytical abilities

Detail oriented

Independent worker

Healthcare IT knowledge

Microsoft Word

Microsoft Excel

Web research

Team player

Travel readiness

Education

High school education

Tools

Microsoft Word

Microsoft Excel

Web research tools

Job description

Invasive Coding Analyst - Ortho

Employment Status: Full time | Shift: Day | Location: 2331 Franklin Rd - Roanoke | Requisition Number: R159966

How You’ll Help Transform Healthcare

• Identify and analyze denials, determine solutions and implement corrections to ensure accurate processing/payments of claims.
• Investigate denial and coding issues related to services provided and associated charges.
• Serve as subject matter expert on payer policies and procedures across multiple payers.
• Make important decisions and determinations regarding claims for payers.
• Identify errors in billing, coding, or procedures related to patient accounts.
• Retrieve and analyze denial reports and provide recommendations based on findings.
• Act as coding and billing expert and resource for RCM Specialists.
• Assist with denial reviews and create denial trending reports for management.
• Identify coding‑related revenue and reimbursement improvement opportunities for Orthopedic Services and report findings to management.
• Consult with physicians to provide education on clinical documentation relative to coding requirements.
• Conduct analysis of complex accounts and determine action steps to resolve accounts.
• Provide guidance to RCM Specialists, serving as a subject‑matter expert.
• Collaborate with Orthopedic Leadership to recommend solutions concerning insurance issues, departmental procedures, and operations.
• Report erroneous processing trends by payer to management.

What We Require

• Education: High school education required.
• Experience: Minimum of 3 years of demonstrated proficiency in coding.
• Licensure/Certification: RHIT, RHIA, CCA, CCS, CPC, or CPC‑H required.
• Other Minimum Qualifications: Effective oral and written communication skills; team player with initiative, organizational skills, analytical abilities, detail oriented; able to work independently; maintain working knowledge of healthcare computer systems; proficient with Word, Excel, and web research for coding and billing information; own transportation for travel to other Carilion work sites.

Compensation Range

$23.23 - $32.52 per hour (Employee pay is based on a variety of factors, including qualifications, credentials, education, and prior work experience). The range does not include benefits or pension plan.

Benefits

• 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 Personify Health wellbeing app
• Discounts on childcare
• Continued education and training

Equal Employment Opportunity

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. For more information or for individuals with disabilities needing special assistance with our online application process contact Carilion HR Service Center at 800-599-2537, 8:00 a.m. to 4:30 p.m., Monday through Friday. For more information on E‑Verify: https://www.carilionclinic.org/eoe-e-verify-and-right-work-policies