We are seeking an experienced
Orthopedic Surgical Coder to join our healthcare revenue cycle team. This role is responsible for accurately reviewing operative reports, medical records, and physician documentation to assign appropriate
CPT, ICD-10-CM, and HCPCS codes for orthopedic surgical procedures.
The ideal candidate has strong hands-on experience in
orthopedic surgical coding, understands complex surgical anatomy and terminology, and can independently interpret detailed operative reports. The successful candidate will ensure coding accuracy, compliance with payer and industry guidelines, and proper reimbursement while maintaining productivity and quality standards.
Key Responsibilities
- Review operative reports, physician documentation, and medical records to accurately assign CPT, ICD-10-CM, and HCPCS codes.
- Code a wide range of orthopedic surgical procedures, including:
- Joint replacement and reconstruction
- Arthroscopy
- Fracture and trauma procedures
- Spine and related orthopedic procedures
- Sports medicine
- Hand and upper-extremity procedures
- Foot and ankle procedures
- Tendon and ligament repairs
- Hardware removal and revision procedures
- Select appropriate CPT codes based on the surgical technique, approach, anatomy, and services documented.
- Apply appropriate modifiers, including -25, -50, -51, -52, -53, -58, -59, -76, -77, -78, and -79, when supported by documentation.
- Apply accurate diagnosis codes and ensure medical necessity is supported by the documentation.
- Review claims for NCCI/CCI edits, bundling issues, global surgery rules, and payer-specific requirements.
- Determine whether services are included in a global surgical package or separately reportable based on documentation.
- Identify coding discrepancies, missing information, and documentation deficiencies.
- Research complex coding questions using official coding guidelines, payer policies, and authoritative coding resources.
- Maintain high levels of coding accuracy, productivity, and turnaround time.
- Assist with coding audits, denial reviews, appeals, and corrective action initiatives as needed.
- Communicate with physicians, clinical staff, and internal revenue cycle teams regarding documentation and coding concerns.
- Stay current with changes to CPT, ICD-10-CM, HCPCS, payer policies, NCCI edits, and orthopedic coding guidelines.
- Maintain strict compliance with HIPAA, company policies, and applicable healthcare regulations.
Qualifications
- 3+ years of professional medical coding experience, with significant experience in orthopedic surgical coding.
- Demonstrated experience coding orthopedic surgical procedures directly from operative reports.
- Strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
- Strong understanding of orthopedic anatomy, terminology, surgical techniques, and common orthopedic procedures.
- Thorough knowledge of modifiers, bundling rules, NCCI/CCI edits, and global surgery guidelines.
- CPC, CCS, COC, or another nationally recognized medical coding certification preferred.
- Experience working with an orthopedic surgery group, ambulatory surgery center, or hospital-based orthopedic department.
- Experience with ModMed or other orthopedic-focused EMR/EHR and billing platforms.
- Experience with surgical claims, payer edits, denials, and coding-related appeals.
- Experience working with multiple commercial payers, Medicare, and workers compensation.
- Experience with coding audits and quality assurance processes.
Perks
- Permanent Work From Home
- Leave Credits
- Monetary Allowance
- Annual Bonus
- Weekly Paychecks
- Fixed Weekends Off
- Thriving Company Culture with Complete Autonomy
- Exclusive Specialized Training Programs
- Unlock Your Potential with a Highly Competitive Salary
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Who are we
BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!
Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.
