We are seeking a detail-oriented and experienced Supervisor/Surgical Specialty Coder – with Specialty in Spinal Surgery who will be a part of the Revenue Cycle Management team. The surgical specialty coder will be responsible for accurately reviewing and coding surgical procedures and related diagnoses, reviewing and correcting claims that have been denied by the insurance payor for coding related issues, ensuring compliance with all applicable coding standards, regulations, and guidelines, as well as communicating and supporting coding rationales to physicians and leadership. Your expertise in surgical specialties, attention to detail, and understanding of medical terminology will support the financial health of the organization and facilitate accurate reimbursement.
Key Responsibilities
Medical Coding:
- Assign accurate CPT, ICD-10-CM, and HCPCS codes for surgical procedures, diagnoses, and related services.
- Review clinical documentation to ensure coding reflects the services provided.
- Understand and apply surgical coding for a wide range of procedures, including but not limited to arthroplasty, laminectomy, and other spine surgeries.
- Research complex surgical cases utilizing CPT, CMS, AMA and specialty society resources & guidelines with organizational standards.
- Communicate coding rationales, with appropriate supporting references, to leadership and physicians.
- Identify missing documentation and work with providers to obtain necessary information for accurate coding.
Compliance:
- Ensure coding practices comply with federal, state, and payer-specific guidelines.
- Stay updated on coding changes, regulatory requirements, and payer policies.
- Participate in audits and quality reviews to maintain compliance and accuracy.
Collaboration and Communication:
- Collaborate with surgeons, healthcare providers, coding and compliance team and billing staff to clarify documentation and coding requirements.
- Provide feedback and education to providers on documentation improvements to support coding accuracy.
Analysis and Reporting:
- Manipulate and review monthly surgical coding reports for coding accuracy.
- Analyze coding trends and identify opportunities for process improvement.
- Assist in resolving coding-related denials or discrepancies with insurance payers.
Training and Development:
- Maintain certification and participate in ongoing education to enhance coding expertise.
- Assist in training new coders or staff in surgical coding best practices and areas of coding development.
Qualifications and Skills
- Education: High school diploma or equivalent required; associate’s degree in a related field preferred.
- Certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS)
- Experience:
- Minimum of 3-5 years of coding experience, with a focus on surgical specialties (e.g., Spine Surgery, Orthopedics, General Surgery, etc.).
- Strong knowledge of anatomy, physiology, and medical terminology specific to surgical procedures.
- Experience in coding decision making, compiling appropriate physician education, and physician queries.
- Skills:
- Strong proficiency in compiling appropriate physician education, and physician queries on surgical cases.
- Ability to make complex surgical coding decisions utilizing coding guidelines, research, and analytical skills based on recognized coding references and organizational standards.
- Proficiency in Microsoft Office Suite: intermediate to advanced Excel skill level.
- Proficiency in coding software and electronic health record (EHR) systems.
- Soft Skills:
- A self-starter with strong initiative and ability to identify and address potential issues before they arise.
- Exceptional analytical, organizational, and problem-solving abilities.
- Strong communication and interpersonal skills for working with diverse teams.
- Ability to prioritize tasks and meet deadlines in a fast-paced environment.