Outpatient Surgery & Pre-Authorization Coder

The Outpatient Surgery & Pre-Authorization Coder is responsible for accurate coding of outpatient surgical encounters while also supporting pre-authorization coding through the assignment of appropriate CPT and related procedure codes.

This position requires a strong outpatient surgical coding background, the ability to interpret clinical documentation across a variety of surgical specialties, and the flexibility to support both surgical coding and pre-authorization workflows based on operational needs.

The role works collaboratively with client coding leadership and clinical teams to maintain timely, accurate coding and efficient queue progression.

Primary Responsibilities

Outpatient Surgery Coding

• Review clinical documentation and accurately assign CPT, ICD-10-CM, and other applicable codes for outpatient surgical encounters.
• Code a variety of outpatient surgical specialties, including:
•  Orthopedics
•  Fracture treatment
•  Knee procedures
•  Limb-length discrepancy procedures
•  Clubfoot procedures
•  Osteotomies
•  Ganz procedures
•  MAGEC/magnetic rod lengthening procedures
•  Casting procedures
•  Cleft lip and palate procedures
•  Dental procedures
•  Hand and upper-extremity procedures
•  Burn laser treatments
• Skin grafts
•  Lesion excisions
•  Circumcision and hypospadias procedures, apply official coding guidelines and client-specific coding requirements consistently.
• Review returned or queried accounts when they become available within the assigned coding queue.
• Escalate documentation questions or coding concerns through established client processes.
• Maintain established productivity, accuracy, and turnaround expectations.

Pre-Authorization Coding

• Review available clinical and procedural documentation to determine appropriate CPT and related procedure codes needed to support the client's pre-authorization workflow.
• Process an average pre-authorization volume of approximately 50 cases per day, recognizing that daily volume may fluctuate.
• Support timely processing of routine and priority/STAT requests.
• Identify cases requiring additional procedural detail before coding can be finalized.
• Communicate with designated care managers when clarification is required.
• Monitor pending cases and return to accounts when additional documentation becomes available.
• Accurately document coding-related notes and follow-up within the client's system.
• Follow established client-specific coding conventions for procedures requiring alternative or multiple codes.

Scope Clarification

This position is focused on coding support for the pre-authorization process and is not responsible for:

• Performing medical-necessity determinations.
• Conducting routine payer-policy or coverage research.
• Obtaining authorization directly from payers.
• Managing the complete authorization lifecycle.
• Routine queue administration or reassignment of work.
• Routine internal coding audits.

Knowledge Transfer & Collaboration

• Participate in structured onboarding and knowledge transfer with existing client staff.
• Learn client-specific surgical and pre-authorization workflows, coding conventions, documentation requirements, and escalation processes.
• Collaborate closely with the client's Coding Supervisor and coding team.
• Support continuity of operations during staffing transitions.
• Maintain clear communication regarding documentation gaps, workflow concerns, or barriers affecting timely coding.

Schedule

• Full-time remote position.
• Expected schedule generally falls between 7:00 AM and 5:00 PM Eastern Time.
• Specific schedule will be established based on client operational needs.
• Start times earlier than 7:00 AM ET are generally not anticipated.

 Qualifications

• Minimum of 3 years of recent outpatient surgery coding experience preferred.
• Demonstrated experience assigning CPT and ICD-10-CM codes for complex outpatient surgical services.
• Strong knowledge of CPT guidelines, surgical coding conventions, and outpatient coding requirements.
• Orthopedic surgical coding experience strongly preferred.
• Experience with multiple surgical specialties is highly desirable.
• Previous experience supporting pre-authorization or pre-service coding workflows preferred but not required.
• Ability to interpret operative notes and other clinical documentation accurately and efficiently.
• Strong attention to detail and demonstrated coding accuracy.
• Ability to work independently within established workflows while communicating effectively with coding leadership and clinical teams.
• Comfortable working in a production-based remote coding environment.
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 Certification One or more nationally recognized coding credentials preferred, such as:

• CCS
• CCS-P
• CPC
• COC
• RHIT
• RHIA