Professional Ortho Surgical Medical Coder - Remote

The Ortho Surgery Pro Fee Coder must be proficient in surgical coding for orthopedic surgery cases. E/M experience is also required.  The Coder will review clinical documentation and diagnostic results, as appropriate, to extract data and apply appropriate ICD-10 diagnosis codes, along with CPT/HCPCS codes, as defined for the service type, for coding, billing, internal and external reporting, research, and regulatory compliance. Under the direction of the Coding Manager, the Coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules, CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The Coder’s scope may involve reviewing coding-related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines. This position is full-time and 100% remote. 

Responsibilities:

• Demonstrate the ability to perform quality surgical coding on orthopedic surgery cases, along with E/M, as assigned.

• Maintain a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing.

• Ensure all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seek to attain proper documentation in a timely manner according to facility standards.

• Achieve and maintain 95% accuracy in coding while sustaining a high level of productivity. Accuracy will be monitored during monthly reviews within the facility.

• Review the coding queue daily to ensure all charts placed in the review queue are addressed, and any corrections are communicated to the facility if necessary.

• Correct and communicate charts requiring re-bills to the facility daily, per the re-bill policy outlined in facility guidelines.

• Report coder downtime immediately to administrative staff to ensure turnaround is met.

• Work directly with the IQC staff to ensure quality standards are met for each facility.

• Provide accurate responses to physicians’ or hospitals’ coding and/or billing questions within eight hours of request.

• Code or pend every chart placed in the queue within 24 hours.

• Notify administrative staff if unable to meet the 24-hour turnaround standard.

• Check the Guidehouse email system at least every two hours during coding sessions.

• Maintain current professional credentials while employed at Guidehouse.

• Become familiar with the Guidehouse coding website and utilize the resources provided as a daily reference tool for accurate coding and abstraction.

• Maintain HIPAA-compliant workstations (refer to HIPAA workstation policy).

• Review and adhere to the Coding Division policy and procedure manual.

• Collaborate effectively with other members of the facility’s coding and billing team to ensure maximum efficiency and reimbursement for properly documented services.

• Communicate problems or discrepancies in coding principles to the supervisor immediately.

• Ensure that all email communication remains professional (refer to email policy).

What You Will Need:

• High school diploma

• 3 years of physician coding experience, including both IP and OP coding for physician claims

• 2-3 years of experience coding orthopedic procedures

• Active CPC certification from AAPC

• EMR experience

• Credential maintenance throughout employment

• Advanced knowledge of Excel, Word, and PowerPoint

• Strong working knowledge and experience with federal and state coding regulations and guidelines

What Would Be Nice to Have:

• COSC credential from AAPC

• 3+ years of orthopedic spine surgical coding experience

• Ability to work independently, multitask, and interface with all levels of personnel and clients

• Excellent verbal, written, and interpersonal communication skills