Coding Specialist

Job Description

Job Description

Description:

Position Summary

TRIARQ Health is searching for a neurosurgical coding professional to join our coding team in a role that spans both surgical coding and the resolution of the denials that coding drives. This is a specialty-specific position, and it carries a minimum requirement of three years of neurosurgery or spine coding experience along with an active coding credential.

The successful candidate codes cranial, spine, and peripheral nerve cases directly from the operative note, and then owns what happens when a payer disputes coding, reworking the claim, drafting the appeal, and closing the documentation gap that created the denial. This role sits on the coding team and partners closely with accounts receivable, so it rewards someone who is equally comfortable in a coding manual, a payer policy, and an AR work queue.

Coding Responsibilities

• Assign ICD-10-CM diagnosis codes, CPT procedure codes, diagnosis pointers, and modifiers from operative notes for cranial, spine, and peripheral nerve cases.
• Code across the surgical continuum: office visits and procedures, hospital admissions and rounding, inpatient and outpatient surgery, ASC cases, and post-operative care.
• Sequence base and add-on codes in the order CPT hierarchy expects, applying per-level versus per-session unit logic and MUE limits.
• Validate technique-dependent add-on codes against the documentation — operating microscope, intraoperative neuromonitoring, and stereotactic navigation — confirming the note supports an integral operative maneuver rather than visualization alone.
• Apply surgical modifiers correctly and defend them on appeal — 50, 51, 59/XS/XU, 62, 80/82, 58/78/79, and 22 with supporting documentation.
• Clear NCCI procedure-to-procedure edits at the coding stage, distinguishing a separately identifiable procedure from an edit that should stand.
• Code the global surgical package correctly, including multiple procedure reductions and professional versus facility split billing for hospital and ASC cases.
• Query surgeons and physician assistants for clarification when documentation is ambiguous, coding to what the note supports.
• Maintain coding accuracy against internal audit standards and payer requirements and participate in internal coding audits.
• Keep coding lag within target so surgical charges drop on schedule.

Denial and Accounts Receivable Responsibilities

• Resolve coding-driven denials, including bundling of decompression with fusion at the same level, levels billed versus levels documented, add-on code sequencing, and MUE and NCCI edits.
• Rework and rebill corrected claims, and draft appeal narratives that cite the operative note, CPT guidelines, and payer policy.
• Work medical necessity, prior authorization, and payer policy denials against spine-specific coverage criteria and Medicare LCDs, including conservative-care and imaging requirements.
• Resolve global surgical package disputes, post-operative visit denials, staged procedure issues, and hardware, implant, and biologics reimbursement.
• Own assigned accounts receivable queues for coding-related balances, prioritizing high-dollar surgical claims and cases nearing appeal or timely filing deadlines.
• Use strategy and tact with insurance companies to resolve accounts, and document all account activity and follow-up.
• Operate medical billing software and proprietary workflow technology.

Documentation and Provider Partnership

• Coordinate with surgeons, physician assistants, residents, and practice staff to close documentation gaps that drive repeat denials.
• Feed recurring coding and documentation findings back to coding leadership and to the providers who generate them.
• Report coding and denial trends by payer, provider, procedure, and denial reason.
• Communicate clinical and account issues clearly to practice staff and internal teams.

Key Results

• Work to reduce then maintain 10% or less 120+ receivables.

• Working denials and rejections in a timely manner, with no appeal missed for timely filing.

• Represent multiple practices and their surgeons in a professional and positive manner.

• Issues identified and resolved within an average of 48 hours.

• Reduce preventable surgical denials by feeding recurring documentation and coding findings back to the coding team and the provider.

• Effective communications with staff and management.

Required

• Minimum three years of neurosurgery or spine surgical coding experience within a billing company, MSO, or surgical practice, including hands-on resolution of coding-driven denials.
• Working knowledge of neurosurgical CPT families — 22xxx arthrodesis and instrumentation, 63xxx decompression, 61xxx cranial, 64xxx nerve and pain procedures — and the ICD-10-CM diagnoses that support them (M43, M48, M50, M51, G95, and related trauma codes).
• Demonstrated command of NCCI PTP and MUE edits, the global surgical package, multiple procedure reductions, assistant and co-surgeon billing, and professional versus facility split billing.
• Ability to read an operative note critically and code to what the documentation supports.
• Payer website and IVR fluency, including commercial portals, Medicare, Medicaid, and workers’ compensation and auto/no-fault where applicable.
• Microsoft Office proficiency, including the ability to work in Excel with claim-level and AR aging data.
• Strong problem-solving skills and attention to detail.
• Comfort adopting new technology, with a willingness to learn new platforms and workflows.

Preferred

• Coding credential preferred (CPC, COSC, CCS, or equivalent), or the ability to work directly and credibly with certified coders on disputed cases.
• Experience querying providers directly and delivering documentation education to surgeons.
• Internal coding audit experience.
• Experience supporting multi-site or multi-state neurosurgery and spine groups.