Invasive Coding Analyst - Ortho

Carilion Clinic•Roanoke, VA

5d•Onsite

About The Position

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 it relates to services provided and associated charges. May require a strong working knowledge of multiple payers knowing payer specific policies and procedures in order to serve as subject matter expert. Makes important decisions and determination by the 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. Investigate and identify errors in billing, coding or procedures relating to patient accounts. Collaboration with leadership in recommending solutions to management related to insurance issues, departmental procedures, and operations. Retrieves and analyzes denial reports and provides recommendations based on findings. The Invasive Coding Analyst May act as coding and billing expert and resource. Assists with denial reviews and creation of denial trending reports for management. Identifies coding-related revenue and reimbursement improvement opportunities for Orthopaedic Services and reports these findings to management. Consults with and provides education to physicians regarding clinical documentation as it relates to coding requirements. Investigate and identify errors in billing, coding or procedures relating to patient accounts. Conducts analysis of complex accounts. Determines actions and completes action steps to resolve accounts. Serving as a subject matter expert and provides guidance to RCM Specialists. Collaboration with Orthopaedic Leadership in recommending solutions to management related to insurance issues, departmental procedures, and operations. Reports any erroneous processing trends by payer to management.

Requirements

High School education required.
Minimum of 3 years of demonstrated proficiency in coding required.
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.
Maintains working knowledge of computer systems used for healthcare operations.
Must be 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.

Responsibilities

Identifies and analyzes denials, determines solutions and implements corrections to result in accurate processing/payment of claims.
Investigates denial and coding issues as it relates to services provided and associated charges.
Makes important decisions and determination by the payers for claims.
Investigate and identify errors in billing, coding or procedures relating to patient accounts.
Collaboration with leadership in recommending solutions to management related to insurance issues, departmental procedures, and operations.
Retrieves and analyzes denial reports and provides recommendations based on findings.
Assists with denial reviews and creation of denial trending reports for management.
Identifies coding-related revenue and reimbursement improvement opportunities for Orthopaedic Services and reports these findings to management.
Consults with and provides education to physicians regarding clinical documentation as it relates to coding requirements.
Conducts analysis of complex accounts.
Determines actions and completes action steps to resolve accounts.
Serving as a subject matter expert and provides guidance to RCM Specialists.
Reports any erroneous processing trends by payer to management.