Job Summary
The Orthopedic Physician Coder is responsible for accurately reviewing, analyzing, and assigning CPT, HCPCS, and ICD-10 codes for professional medical services documented in patient records. This role ensures compliance with government regulations, payer policies, and organizational standards while maintaining coding integrity, supporting reimbursement accuracy, and promoting documentation excellence across orthopedic services.
Essential Functions
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Accurately assign CPT, HCPCS, and ICD-10 codes for procedures, diagnoses, and treatments based on physician documentation.
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Ensure compliance with federal regulations, third-party payer policies, and internal coding protocols, including NCCI edits, LCDs, and NCDs.
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Conduct coding audits and quality checks to verify accuracy and identify opportunities for provider education.
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Resolve claim edits, billing holds, and scrubbing errors in systems such as Athena Collector to support timely reimbursement.
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Collaborate with physicians, coding education teams, and revenue cycle staff to clarify documentation and ensure compliance.
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Perform edit checks on coded data before claim submission, correcting any identified errors.
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Maintain confidentiality of all patient and provider data in compliance with HIPAA standards.
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Escalate documentation or coding discrepancies for provider training and performance improvement.
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Participate in special projects, contributing to data accuracy and operational enhancements.
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Comply with all organizational policies, standards, and compliance guidelines.
Qualifications
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Education:
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High School Diploma or GED required.
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Associate degree in Health Information Management, Healthcare Administration, or a related field preferred.
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Experience:
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2–4 years of experience in physician or professional fee coding required.
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Experience in orthopedic or surgical coding and high-volume environments preferred.
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Knowledge, Skills, and Abilities
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Proficiency in ICD-10, CPT, and HCPCS coding for physician services.
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Strong understanding of modifier use, place-of-service coding, and payer-specific billing rules.
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Experience with EHRs, coding software, and claims management systems.
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Ability to identify and communicate documentation deficiencies for provider education.
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Knowledge of NCCI edits, LCD/NCD guidelines, and medical necessity requirements.
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Excellent analytical, communication, and problem-solving skills to ensure coding accuracy and compliance.
Licenses and Certifications
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Certified Professional Coder (CPC) – AAPC, or
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Certified Coding Specialist – Physician (CCS-P) – AHIMA required.
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Additional certifications such as CEMC or RHIT preferred.