Certified Coding Specialist

What you’ll do:

The Certified Coding Specialist is responsible for accurate and compliant coding of complex orthopedic procedures across all care settings. This role directly impacts revenue integrity by ensuring optimal CPT/ICD-10 coding, minimizing denials, and supporting provider’s documentation improvement.

Responsibilities/Duties:

Complex Surgical Coding Code high-complexity orthopedic and neurosurgical procedures

Verifying all documentation is complete and compliant

Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.

Follows coding conventions and ensure accurate assignment of:

CPT (including add-on codes, modifiers, bundling rules)
ICD-10 diagnoses supporting medical necessity

Validate:

Levels, laterality, approach (anterior/posterior)
Instrumentation and graft usage

Identify missed billable components (e.g., additional levels, hardware, biologics)
Query provider for any necessary clarification related to unclear, unspecified or missing/incomplete documentation

Apply payer-specific coding rules and edits

Denial Prevention & Root Cause Ownership Researches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future coding errors:

Review coding-related denials (medical necessity, bundling, documentation)
Perform root cause analysis and trend identification

Partner with RCM and vendor teams to implement corrective actions

Develop coding edits and pre-bill review processes for high-risk procedures

Pre-Bill Quality Review Perform targeted pre-bill audits for:

High-dollar orthopedic surgeries

Multi-level and complex cases

Ensure documentation supports:

Medical necessity

Procedure specificity

Escalate documentation gaps prior to claim submission

Provider Documentation Improvement Partner with surgeons to improve documentation quality

Provide targeted, case-based feedback:

Missing elements impacting coding accuracy

Opportunities to fully capture procedure complexity

Support education on:

Modifier usage

Documentation specificity (levels, implants, approach)
Vendor Oversight & Coding Quality Control Audit external coding vendor performance (if applicable)
Identify discrepancies between internal and vendor coding

Provide feedback and enforce coding standards

Support development of SOPs and coding guidelines

Serves as primary resource and Spire Point of Contact (SPOC) between provider and vendor

Appeals

Support appeals for coding-related denials

Provide clinical/coding rationale and documentation validation

Partner with AR teams on high-value accounts

Who you are:

Required Qualifications CPC, CCS, or equivalent certification (AAPC or AHIMA)5+ years of surgical coding experience

Deep knowledge of:

NCCI edits and bundling rules

Modifier usage (e.g., 22, 25, 50, 51, 57, 59, 62, 76)
Orthopedic and Spine-specific CPT coding nuances

Documentation requirements for Evaluation and Management services

Experience with orthopedic or multi-specialty groups preferred

Excellent organization skills

Detailed oriented and comfortable with multi-tasking

Ability to work in face-paced, results driven position

Administer and uphold all the Company’s values and policies and procedures.

Continuously work towards the Company’s goal and vision.

Performs other duties as assigned.

Preferred Qualifications COSC specialty certification (AAPC)
Experience working in a high-volume orthopedic/spine practice

Exposure to vendor-managed RCM environments

Familiarity with systems like Mod Med or athenahealth

What we offer:

Excellent growth and advancement opportunities

Dynamic environment

Access to a diverse network of practitioners

Broad infrastructure of tools and programs to enhance the employee experience

Competitive Compensation Generous PTO Benefits package: health, dental, vision,…