Role Description Inova Health is looking for a dedicated Coding Validation Specialist 3 to join the team. Full-time Day Shift: Monday–Friday, general office hours, working remotely. - Codes and reviews assigned records with defined productivity standards of four charts per hour for complex/intermediate surgeries and five charts per hour for simple surgeries. - Actively participates in internal pre-bill coding audits, independent coding audits, and coding education sessions. - Enhances professional growth and development by participating in other relevant continuing education activities. - Maintains or surpasses Inova Health System-defined quality standards for accurate assignment and validation of the Evaluation and Management (E/M) assignment of 95 percent. - Ensures correct CPT code for the level of service billed (i.e. Place of Service, Observation codes for Observation Status; Inpatient Codes for Inpatient Status). - Changes consult codes based on Payer requirements to the appropriate E/M code and appropriate units and/or modifiers maintaining an accuracy of 95 percent or greater. - Verifies the accuracy, completeness, and quality of ICD-10-CM, CPT-4, and HCPC coding including modifiers, units, and other variables impacting workload accountability and billing. - Communicates with the responsible physician or mid-level provider accordingly to obtain additional supporting documentation, or clarification required for code assignments and processes, including following an escalation or secondary review as necessary. Qualifications - High School diploma or GED - Three years of coding experience required. - One of the following certifications: RHIT, CCS or CPC, COC or CCS-P. Preferred Qualifications - Strong general surgery coding experience Benefits - Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. - Retirement: Inova matches the first 5% of eligible contributions – starting on your first day. - Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. - Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. - Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities. Company Description We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.

• Reviews system edits and assigns appropriate codes from appropriate coding classification system to ensure the production of quality healthcare data and accurate professional payment • Prepares reports for designated leader(s) • Uses knowledge of coding systems and system logic to review codes created by electronic charge capture and/or assign appropriate codes through medical record documentation as per designated workflow • Completes system edit reviews to make corrections before transmittal • Ensures work queue and responsibilities are handled within established guidelines and timeframes • Troubleshoots problems that prevent claims from being released • Identifies cause of edit and independently resolves issue by reviewing the patient encounter to understand the nature of the problem • Consults with internal customers and external vendors to obtain greater specificity and/or clarification when documentation appears inconsistent or incomplete • Prepares reports for designated leader to document recurring problems and identifies the source of reimbursement delays • Works closely with designated leader to ensure effective communication to resolve invoice payment delays • As necessary, provides Providers and other staff with information relative to coding • Responds to coding information requests and inquiries from various sources • Other duties as assigned

Role Description The Denials Specialist will be responsible for researching, analyzing, resolving and trending rejections and/or denials specific to the revenue cycle. This includes, but is not limited to: - Analyzing specific denial categories and codes. - Researching the underlying reason for the denial. - Rectifying the issue in the patient management system. - Ensuring that the claim is adjudicated. The Denials Specialist should be able to: - Identify potential process improvement opportunities. - Offer recommendations for correcting issues. - Understand how various components of the revenue cycle can cause a denial. - Be a problem solver and utilize available resources to rectify a denial. Additional responsibilities include: - Analyzing Managed Care contracts and reconciling payments received. - Contacting insurance companies to have adjustments processed and/or file appeals. - Direct interaction with Managers and/or Department Heads regarding administrative issues related to rejections and/or denials. Qualifications - High school diploma, equivalent or higher. - 5 or more years of experience in billing, A/R follow up, denials management & appeal writing. Requirements - Proficient in payment review systems, hospital information systems and coding methodologies. - Strong quantitative, analytical and organizational skills. - Advanced understanding of an Explanation of Benefits (EOB). - Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards. - Understand CMS Memos and Transmittals. - Understand medical records, professional claims, and the Charge master. - Utilize and understand computer technology. - Understand all ancillary charges and multi-specialty departmental functions. - Communicate orally and in written form. - Understand insurance terms and payment methodologies. - Work effectively with physicians, administrative staff, and department managers. - Identify accurate Revenue code(s), CPT codes, and HCPCS codes for services/items. - Identify clerical errors, mistakes in interpretation, imprecise records, and inaccurate service code assignment. - Perform reviews for appropriateness of coding and charging. Benefits - Pay Range: $24.69 - $35.99/hr - Remote role (based out of Greenville, NC) - Monday - Friday day shift: 8:00 a.m. - 5:00 p.m. ET - Great Benefits

Role Description This role is responsible for analyzing coding denials by insurance carriers, CPT code(s), and specialty area, review and submission of coding appeals related to denials to include coding, bundling, duplicate, and other assigned denial volume. As well as responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims and accounts. Perform detailed analysis on denied assigned claims with a focus on maximizing revenue and reimbursement. Utilizes provider documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review process. - Review and analyze coding, bundling, and duplicate denials including identification of root cause. - Resolve coding denials which include researching and reviewing payer coding guidelines, writing and submitting appeals with supporting documentation. - Analyzing assigned denials and making necessary corrections or modifications. - Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted. - Identify and provide coding denial trends by Payer, CPT code, or any other denial parameters. - Performs searches of governmental, payor-specific, guidelines to identify coding and billing requirements to make recommendations. - Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes for denials of payment and partners with management to implement strategies to prevent future denials. - Integrates the payer medical policies, case specific medical documentation, and claims information into a concise appeal letter, including appropriate medical records submission. - Performs timely review of medical records and remittances for denials in order to determine root cause and appropriateness. - Partners with revenue cycle leadership, peers and clinical operations to reduce denials. - Reviewing claim edits and denials and/or inquiries referred from other departments and assists in identifying root causes. - Investigates the validity of the reasons for the denials and determines the need for or feasibility of submitting appeals. - Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations. - Develop process improvement initiatives from which problems can be resolved. - Documents results of all special projects and provides recommendations for revenue managing opportunities. Qualifications - Minimum of bachelor's degree or higher in a health service-related discipline. - Five years of denial recovery experience or revenue cycle related field with a certificate in coding may be substituted. - Previous auditing experience preferred. - National Certification in an area relevant to Revenue Management or Coding is preferred. Requirements - Proficient in reimbursement methodologies, hospital information systems and coding methodologies. - Illustrates creative problem-solving skills through documentation of process improvement reporting and/or internal reporting mechanisms. - Ability to analyze complex medical records and identify billable services. - Strong quantitative, analytical, and organizational skills. - Understanding of medical records, professional/hospital claims, and the Charge master. - Ability to utilize and understand computer technology. - Ability to understand ancillary department functions. - Possesses a comprehensive knowledge of various payment and coding methodologies, including ICD-10, HCPCS and CPT-4 coding schemes. - Possesses a working knowledge of the UB-04/837 claim form loop and segments. - Understands charging, coding processes along with compliance issues. - Has the ability to provide resolutions by performing internet research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and CMS guidelines. - Requires knowledge of medical terminology, anatomy and physiology. - Must be team-oriented with strong interpersonal skills. - Knowledge of the Privacy Act to safeguard patient confidentiality. - Certified Coding Specialist or Certified Procedural Coder. Benefits - Remote role (based out of Greenville, NC) - Monday - Friday day shift: Start/end times flexible between 6:00 a.m. - 6:00 p.m. - Great Benefits Company Description ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.