Certified Coding Specialist

What you’ll do:The Certified Coding Specialist is responsible for accurate and compliant coding of complex orthopedic procedures across all care settings. This role directly impacts revenue integrity by ensuring optimal CPT/ICD-10 coding, minimizing denials, and supporting provider’s documentation improvement.Responsibilities/Duties:Complex Surgical CodingCode high-complexity orthopedic and neurosurgical proceduresVerifying all documentation is complete and compliantAssigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.Follows coding conventions and ensure accurate assignment of:CPT (including add-on codes, modifiers, bundling rules)ICD-10 diagnoses supporting medical necessityValidate:Levels, laterality, approach (anterior/posterior)Instrumentation and graft usageIdentify missed billable components (e.g., additional levels, hardware, biologics)Query provider for any necessary clarification related to unclear, unspecified or missing/incomplete documentationApply payer-specific coding rules and editsDenial Prevention & Root Cause OwnershipResearches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future coding errors:Review coding-related denials (medical necessity, bundling, documentation)Perform root cause analysis and trend identificationPartner with RCM and vendor teams to implement corrective actionsDevelop coding edits and pre-bill review processes for high-risk proceduresPre-Bill Quality ReviewPerform targeted pre-bill audits for:High-dollar orthopedic surgeriesMulti-level and complex casesEnsure documentation supports:Medical necessityProcedure specificityEscalate documentation gaps prior to claim submissionProvider Documentation ImprovementPartner with surgeons to improve documentation qualityProvide targeted, case-based feedback:Missing elements impacting coding accuracyOpportunities to fully capture procedure complexitySupport education on:Modifier usageDocumentation specificity (levels, implants, approach)Vendor Oversight & Coding Quality ControlAudit external coding vendor performance (if applicable)Identify discrepancies between internal and vendor codingProvide feedback and enforce coding standardsSupport development of SOPs and coding guidelinesServes as primary resource and Spire Point of Contact (SPOC) between provider and vendorAppealsSupport appeals for coding-related denialsProvide clinical/coding rationale and documentation validationPartner with AR teams on high-value accountsWho you are:Required QualificationsCPC, CCS, or equivalent certification (AAPC or AHIMA)5+ years of surgical coding experienceDeep knowledge of:NCCI edits and bundling rulesModifier usage (e.g., 22, 25, 50, 51, 57, 59, 62, 76)Orthopedic and Spine-specific CPT coding nuancesDocumentation requirements for Evaluation and Management servicesExperience with orthopedic or multi-specialty groups preferredExcellent organization skillsDetailed oriented and comfortable with multi-taskingAbility to work in face-paced, results driven positionAdminister and uphold all the Company’s values and policies and procedures.Continuously work towards the Company’s goal and vision.Performs other duties as assigned.Preferred QualificationsCOSC specialty certification (AAPC)Experience working in a high-volume orthopedic/spine practiceExposure to vendor-managed RCM environmentsFamiliarity with systems like ModMed or athenahealthWhat we offer:Excellent growth and advancement opportunitiesDynamic environmentAccess to a diverse network of practitionersBroad infrastructure of tools and programs to enhance the employee experienceCompetitive CompensationGenerous PTOBenefits package: health, dental, vision, 401(k), etc.We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).The final pay offered to a successful candidate will be dependent on several factors that may include but are not limited to the type and years of experience within the job, the type of years and experience within the industry, education, etc. #J-18808-Ljbffr