Orthopedic Surgery & ASC Coder / Revenue Cycle Specialist

Job Description: Orthopedic Surgery & ASC Coder / Revenue Cycle Specialist

Position Title: Orthopedic Surgery & ASC Coder / Revenue Cycle Specialist

Department: Revenue Cycle Management

Reports To: Revenue Cycle Director / Billing Manager

Position Summary

The Orthopedic Surgery & ASC Coder / Revenue Cycle Specialist is responsible for accurate coding and charge capture for orthopedic surgical procedures performed in both the physician practice and Ambulatory Surgery Center (ASC) settings. This role will support the Revenue Cycle team through claim follow-up, denial management, payment review, reimbursement analysis, and special projects aimed at improving revenue integrity and operational efficiency. The ideal candidate is highly detail-oriented, knowledgeable in orthopedic and ASC coding regulations, and comfortable collaborating across billing, collections, and administrative teams.

Essential Duties and Responsibilities

Coding Responsibilities

· Review operative reports, physician documentation, and medical records to assign accurate ICD-10-CM, CPT, HCPCS, and modifier coding.

· Code orthopedic surgical procedures for physician professional services and ASC facility claims.

· Ensure coding compliance with payer, CMS, Medicare, Medicaid, Workers' Compensation, and commercial insurance guidelines.

· Review documentation for completeness and communicate with providers regarding coding clarification opportunities.

· Assist with charge entry review and validation to ensure accurate reimbursement.

· Identify coding trends, edits, and revenue opportunities while maintaining compliance standards.

· Stay current on coding updates, payer policies, National Correct Coding Initiative (NCCI) edits, and regulatory changes.

Revenue Cycle Responsibilities

· Perform follow-up on unpaid, underpaid, denied, and aging accounts receivable claims.

· Investigate reimbursement discrepancies and coordinate claim resolution with payers.

· Analyze Explanation of Benefits (EOBs), remittance advice, and denial reasons.

· Prepare and submit appeals for denied, reduced, and incorrectly processed claims.

· Collaborate with billing representatives, adjusters, providers, and payer representatives to resolve outstanding claims.

· Assist with Workers' Compensation claim follow-up and reimbursement negotiations as needed.

· Support collection and reconciliation of outstanding accounts and revenue recovery initiatives.

Reporting & Analytics

· Generate and maintain routine revenue cycle reports.

· Assist with tracking key performance indicators (KPIs), including:

o Days in A/R

o Denial rates

o Collection percentages

o Underpayment trends

o Aging inventory

· Utilize Excel and reporting tools to support revenue cycle management and decision-making.

· Provide data analysis and recommendations to improve reimbursement outcomes and operational efficiency.

Special Projects

· Participate in revenue cycle improvement initiatives and process optimization projects.

· Assist with payer audits, reimbursement reviews, and coding compliance assessments.

· Support implementation of new billing workflows, software systems, and payer requirements.

· Participate in special projects related to denial prevention, reimbursement enhancement, and operational excellence.

· Cross-train in additional revenue cycle functions as needed.

Qualifications

Required

· Certified Professional Coder (CPC), CCS, or equivalent coding certification.

· Minimum of 3 years of orthopedic surgery coding experience.

· Minimum of 2 years of ASC facility coding experience.

· Strong knowledge of ICD-10-CM, CPT, HCPCS, and modifier usage.

· Experience with commercial insurance, Medicare, Workers' Compensation, and managed care payers.

· Familiarity with orthopedic surgical procedures, spinal procedures, joint replacement, sports medicine, and pain management coding.

· Experience reviewing operative reports and physician documentation.

· Proficiency in Microsoft Excel and practice management systems.

Preferred

· Experience with workers' compensation reimbursement and appeals.

· Experience with denial management and accounts receivable follow-up.

· Knowledge of ASC reimbursement methodologies and payer contract analysis.

· Experience with electronic health records (EHR) and ASC management software.

· Advanced Excel reporting and data analysis skills.

Knowledge, Skills, and Abilities

· Strong analytical and problem-solving skills.

· Excellent attention to detail and accuracy.

· Ability to prioritize multiple projects and meet deadlines.

· Strong written and verbal communication skills.

· Ability to work independently while collaborating with cross-functional teams.

· Strong understanding of healthcare reimbursement methodologies and revenue cycle processes.

· Professionalism and commitment to maintaining confidentiality and compliance standards.

Physical Requirements

· Prolonged periods of sitting and computer use.

· Ability to review medical records and reports electronically.

· Occasional participation in meetings and training sessions.

Position Type

· Full-Time, Working Hours are Central/Standard Time

· Remote or Hybrid Considered

· Competitive Salary Based on Experience

Ideal Candidate Profile

This position is ideal for a coder who enjoys going beyond coding and actively contributing to revenue cycle performance. The successful candidate will be comfortable balancing coding responsibilities with claims follow-up, denial resolution, reimbursement analysis, reporting, and special projects that directly impact organizational financial success.