Orthopedic Coding & Denials Analyst

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

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.