Orthopedic Coder

Position Summary  

The Professional Coder is responsible for accurately reviewing clinical documentation and assigning diagnosis codes, CPT codes, and other required codes for professional services across assigned specialties. This role applies official coding guidelines, regulatory requirements, and payer-specific rules to ensure accurate code selection, clean claim submission, and timely reimbursement. By ensuring coding accuracy and compliance, the Professional Coder plays a critical role in optimizing revenue cycle performance, reducing claim denials and audit risk, supporting regulatory compliance, and contributing to the organization's overall financial health and operational success. 

Key Responsibilities  

Coding Production & Accuracy  

• Review clinical documentation and accurately assign diagnosis and procedure codes for professional services in accordance with official coding guidance and payer requirements  
• Code assigned tickets accurately and in a timely manner to support clean claim submission and maximize appropriate reimbursement  
• Independently research and resolve coding scenarios, including payer-specific edits and documentation questions, using available resources and tools  
• Meet daily productivity targets and maintain consistent coding quality 

Communication & Escalation Management  

• Communicate coding and documentation issues, trends, and potential risks to the Lead Medical Coder and/or Medical Coding Manager  
• Escalate complex scenarios or unclear documentation through established workflows to support timely resolution  

Compliance, Confidentiality & Continuous Learning  

• Maintain current knowledge of coding guidelines and payer policies;  maintain required credentials in good standing  
• Participate in department meetings and ongoing education; demonstrate flexibility to expand coding skills into additional specialties as business needs evolve  
• Perform other duties as assigned by leadership  

Performance Metrics  

• Complete coding for all cases assigned within a 48 hour period 
• Daily productivity output against established targets  
• Individual coding accuracy rate (target: 95%+)  
• Escalation timeliness and documentation quality  
• Credential maintenance and continuing education compliance  

Qualifications 

• Successful completion of an AHIMA or AAPC-approved coding program with an active credential in good standing (e.g., CPC, CCS); CPC preferred   
• Minimum of 3 years of recent hands-on physician/professional services coding experience across one or more specialties   
• Proficient knowledge of anatomy and physiology, medical terminology, CPT, ICD-10-CM, modifiers, disease processes, and applicable Medicare/Medicaid policies for professional services  
• High School Diploma or equivalent required; Associate’s or Bachelor’s degree preferred  
• Proficiency in Microsoft Office applications (Excel, Word, Outlook); experience with reporting and data analysis tools preferred  
• Proven ability to multi-task, prioritize workload, and meet deadlines in a fast-paced environment  
• Strong communication and interpersonal skills  
• Experience coding professional services across multiple specialties and service lines (e.g., surgical, anesthesia, E/M) preferred 
• Experience using encoder tools and working within queue-based workflow systems to manage volume and turnaround time preferred 
• Prior participation in coding audits, denial prevention initiatives, or documentation improvement efforts preferred 

Additional Qualifications  

• In-depth knowledge of HIPAA regulations and healthcare privacy laws; maintains strict compliance at all times.  
• Exceptional attention to detail and organizational skills.  
• Ability to work independently while contributing to a team-oriented environment  
• Demonstrated problem-solving skills with a proactive and solution-driven approach