As a Certified Medical Coder specializing in Orthopedic Surgery, you will play a pivotal role in ensuring accurate documentation, coding, and billing for orthopedic procedures and services provided by our practice. You will collaborate closely with healthcare providers, billing specialists, and compliance to uphold coding integrity, maximize reimbursement, and maintain compliance with regulatory requirements and payer guidelines. In this role you will contribute to our mission of delivering high-quality orthopedic care by ensuring accurate coding and billing practices. Your expertise and attention to detail will play a critical role in optimizing revenue, minimizing compliance risks, and ultimately improving patient outcomes.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Coding and Abstracting
• Chart Review/Auditing/Education and training
• Billing support and compliance resource
• Compliance and Quality assurance/Documentation

1. Coding and Abstracting:

• Accurately assign Current Procedural Terminology (CPT), International Classification of Diseases (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) codes to orthopedic surgeries, consultations, and services based on thorough review and interpretation of medical record documentation.
• Ensure coding accuracy and completeness while adhering to established coding guidelines, including those set forth by the American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS), and other regulatory bodies.

2. Chart Review:

• Conduct comprehensive reviews of patient medical records to extract pertinent information related to diagnoses, procedures, treatments, and clinical findings relevant to orthopedic care.
• Collaborate with healthcare providers to clarify documentation, address discrepancies, and ensure proper documentation of medical necessity and procedural details.

3. Billing Compliance:

• Work closely with billing specialists to ensure accurate and timely submission of claims for orthopedic services rendered, including surgical procedures, office visits, diagnostic tests, and durable medical equipment.
• Identify and resolve coding-related denials, discrepancies, and rejections in collaboration with billing and compliance teams.

4. Documentation Improvement:

• Identify opportunities for documentation improvement to support accurate code assignment, optimize reimbursement, and mitigate compliance risks.
• Provide feedback and education to healthcare providers and clinical staff on documentation best practices, coding requirements, and compliance standards.

5. Coding Education and Training:

• Stay current on updates and changes in orthopedic surgery coding guidelines, regulations, and technology advancements.
• Develop and deliver coding education and training programs for healthcare providers and staff to promote coding accuracy, compliance, and revenue integrity.

6. Quality Assurance:

• Participate in regular coding audits and quality assurance initiatives to evaluate coding accuracy, identify trends, and implement corrective actions as needed.
• Collaborate with internal audit teams, compliance officers, and external auditors to ensure coding integrity and compliance with regulatory requirements.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this position. Duties, responsibilities, and activities may change at any time with or without notice.

QUALIFICATIONS:

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credential required.
• Minimum of five [5] years of experience in medical coding, with a focus on orthopedic surgery OR orthopedic spine coding required.

REQUIRED SKILLS:

• In-depth knowledge of CPT, ICD-10, and HCPCS coding systems and guidelines related to orthopedic surgery procedures and diagnoses.
• Proficiency in medical terminology, anatomy, and physiology.
• Strong analytical skills and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to work independently and collaboratively in a fast-paced, team-oriented environment.

PAY RANGE: $32-$41hr