Medical Coder

Position Overview

Specialty Orthopedic Group is seeking a detail-oriented and knowledgeable Medical Coder to review clinical documentation and translate healthcare services, procedures, and diagnoses into standardized medical codes. The ideal candidate ensures accurate code assignment for billing, statistical reporting, and compliance while working collaboratively with physicians, clinical staff, and the billing team. The main challenge of this role centers around the ability to work quickly, accurately, and independently. Coders need to meet daily production goals, and a quality 95 % accuracy rate every month. Extensive use of electronic medical records in an ICD-10 environment is also required.

Key Responsibilities

• Code Assignment: Review patient medical records and accurately assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II codes according to official coding guidelines.
• Documentation Review: Analyze clinical charts, operative notes, and provider documentation to verify medical necessity and identify documentation gaps.
• Query Management: Communicate professionally with physicians and clinical staff through formal physician queries to clarify ambiguous, conflicting, or incomplete documentation.
• Compliance & Auditing: Maintain strict adherence to official coding rules, HIPAA regulations, CMS standards, and internal billing policies; participate in routine internal coding audits.
• Denials & Edits: Review and resolve claim edits (e.g., NCCI, MUEs) and assist the revenue cycle team in investigating and appealing coding-related denials.
• Production & Quality Standards: Consistently meet or exceed organizational productivity targets (e.g., 10 charts/hour surgical cases, 4 charts/hour in A/R and Denials) while maintaining an audit accuracy rate of , 95% or higher.

Qualifications & Requirements

Required:

• Education: High school diploma or equivalent and completion of an accredited medical coding or health information program. (RHIT, RHIA, CCST, CCS)
  • Strong knowledge of CPT, ICD-10, HCPCS, and modifier usage.
  • Experience with EHR and practice management systems.
  • Familiarity with Medicare, Medicaid, and commercial payer policies.
• Experience: Minimum of 2+ years of medical coding experience (orthopedics highly preferred).
• Technical Proficiency: Hands-on experience with electronic health records (EHR/EMR) systems and computer-assisted coding (CAC) software.
• Knowledge Base: Strong working knowledge of anatomy, physiology, medical terminology, pharmacology, and reimbursement methodologies.
• Job Quality:
  • Must display sophisticated writing and interpersonal communication skills and very good attention to detail.
  • Ability to apply written instructions and standardized work practices.
  • Excellent organizational and time management skills.
  • Ability to work independently and as a team member for successful outcomes.
  • Must be efficient in Microsoft Excel and Word.

Preferred:

• Orthopedic coding experience strongly preferred.
• Certified Orthopedic Coder (COSC) preferred.
• Strong billing and collection experience with knowledge of health insurance plans, policies.
• Prior experience working in a remote or hybrid production environment.