Code outpatient services including diagnostics, recurring visits, and procedures performed in orthopedic settings.
Ensure coding supports reimbursement, medical necessity, and regulatory compliance.
Collaborate with providers and clinical staff to clarify documentation and resolve coding discrepancies.
Monitoring payer-specific authorization requirements and support appeals when authorizations are not obtained timely.
Submit appeals with supporting documentation when oversight occurs, requesting reconsideration based on medical necessity.
Understand payer contracts and recognize limitations in appeal success due to provider-side authorization delays.
Maintain up-to-date knowledge of coding guidelines, payer policies, and regulatory changes
Contributes accurate reporting for morbidity, mortality, research, and statistical analysis.
Participate in meetings and training sessions to support continuous improvement and compliance.
Serve as a mentor or resource to Coder I team members, offering guidance on complex coding scenarios and best practices.
Maintain thorough documentation of coding activity and adhere to departmental standards for timeliness and accuracy.
Minimum Qualifications
Certification: CPC, CCS, or equivalent coding credential (active and in good standing).
Experience: Minimum 3 years of professional coding experience, with demonstrated expertise in orthopedic and surgical coding.
Education: High school diploma or equivalent required; associate degree or higher in health information management or related field preferred.
Advanced understanding of anatomy, medical terminology, and surgical procedures across orthopedic and related specialties.
Proficiency with electronic health record (EHR) systems and coding software.
Preferred Skills
Strong working knowledge of Microsoft Office products, especially Word, Excel, and Teams.
Ability to interpret complex clinical documentation and apply nuanced coding guidelines with precision.
High level of attention to detail, critical thinking, and problem-solving skills.
Familiarity with payer-specific rules, inclusive billing practices, and appeals processes.
Effective communication and collaboration skills across multidisciplinary teams.
Commitment to professional development and staying current with industry changes and regulatory updates.
Compensation Range for this position
$20.96 - $31.44
Compensation for this role will be based on several factors, including the candidate's qualifications, relevant experience, education, skills, certifications, geography/market, and internal equity considerations.
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