Senior Medical Coder

Orthopedic Surgery Coder/ MedDRA Coder | Sleep Study Coder| BPT| MPT| B.Pharma | M.Pharma

The Orthopedic Surgery Coder is responsible for accurately reviewing, analyzing, and assigning appropriate CPT, ICD-10-CM, and HCPCS codes for orthopedic surgical procedures and related services. This role ensures that all coding meets federal regulations and payer-specific requirements to maximize appropriate reimbursement and maintain compliance.

Note: Claim Adjudication Experience would be preferred.

Key Responsibilities:

Review operative reports, clinical documentation, and physician notes to assign accurate codes for orthopedic surgeries and related encounters.

Apply CPT, ICD-10-CM, and HCPCS Level II coding standards according to official coding guidelines.

Ensure coding accuracy for procedures including, but not limited to, joint replacements, arthroscopies, fracture repairs, spine surgeries, and trauma cases.

Query physicians when documentation is incomplete or unclear to ensure proper coding and compliance.

Collaborate with billing and compliance teams to resolve coding discrepancies or denials.

Stay current with coding updates, payer guidelines, and orthopedic surgery terminology.

Participate in internal and external audits to ensure data integrity and compliance.

Maintain productivity and accuracy standards as defined by department policies.

Qualifications & Skills:

Education: High school diploma or equivalent (Required); Associates or Bachelors in Health Information Management or related field (Preferred).

Certification:

Required: CPC (Certified Professional Coder) or COC (Certified Outpatient Coder) through AAPC, or CCS (Certified Coding Specialist) through AHIMA.

Preferred: COSC (Certified Orthopaedic Surgery Coder) or specialty certification in Orthopedics.

Experience:

Minimum 23 years of experience coding orthopedic surgery cases in a hospital or professional setting.

Strong understanding of surgical anatomy and terminology specific to orthopedics.

Skills:

Excellent knowledge of CPT, ICD-10-CM, and HCPCS coding systems.

Strong attention to detail and accuracy.

Ability to read and interpret operative reports.

Good communication and query skills with providers.

Familiarity with EHR systems (e.g., Epic, Cerner, Allscripts) and coding software.

Performance Metrics:

Coding accuracy: 95%

Productivity standards as defined by department

Timely completion of coding within turnaround deadlines

Compliance with all payer and regulatory requirements