Medical Coder

The Medical Coder / Coder PAR at Apex Spine and Neurosurgery is responsible for reviewing clinical documentation and assigning accurate CPT, ICD-10, and HCPCS codes for spine, neurosurgical, and interventional pain management services. This role ensures compliant, complete, and timely coding to support revenue integrity, authorization accuracy, and efficient claims processing in accordance with CMS and payer guidelines.

Key Responsibilities

• Review operative reports, clinic notes, imaging, and diagnostic studies to accurately assign CPT, ICD-10, and HCPCS codes for spine and neurosurgical procedures.
• Code surgical and procedural services including (but not limited to): spine surgeries, decompressions, fusions, discectomies, laminectomies, injections, nerve blocks, ablations, and other interventional pain procedures.
• Ensure compliance with CMS guidelines, NCCI edits, payer-specific policies, and internal coding standards.
• Communicate directly with physicians and advanced practice providers to clarify documentation and ensure accurate coding and medical necessity.
• Support prior authorization (PAR) processes by reviewing documentation, validating codes, and ensuring alignment with payer requirements.
• Enter codes into the EHR/billing system and confirm documentation supports all billed services.
• Collaborate with billing and authorization teams to resolve coding edits, denials, and discrepancies.
• Assist with internal and external audits, compliance reviews, and coding workflow improvements.
• Stay current with annual CPT/ICD updates, CMS rules, spine and neurosurgery coding changes, and payer policy updates.
• Participate in provider education related to documentation requirements, surgical reporting, and medical necessity standards.

Qualifications

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required.
• Minimum of 3–5 years of medical coding experience, preferably in spine surgery, neurosurgery, orthopedics, interventional pain management, or a related surgical specialty.
• Strong working knowledge of CPT, ICD-10, HCPCS, NCCI edits, and CMS guidelines.
• Experience reading and interpreting operative reports and procedural documentation.
• Familiarity with EMR/EHR systems and coding/billing software.
• Excellent attention to detail, organization, and problem-solving skills.
• Strong communication skills with providers, clinical staff, and revenue cycle teams.