Certified Coding Specialist

Spire Orthopedic Partners•Stamford, CT

23d•$32 - $40

About The Position

The Certified Coding Specialist is responsible for accurate and compliant coding of complex orthopedic procedures across all care settings. The role supports revenue integrity through optimal CPT and ICD-10 coding, denial prevention, and provider documentation improvement. The specialist also conducts pre-bill quality reviews, analyzes coding-related denials, collaborates with providers and revenue cycle teams, oversees external coding quality when applicable, and supports appeals.

Requirements

CPC, CCS, or equivalent AAPC or AHIMA certification.
At least 5 years of surgical coding experience.
Deep knowledge of NCCI edits and bundling rules.
Knowledge of modifier usage, including modifiers 22, 25, 50, 51, 57, 59, 62, and 76.
Knowledge of orthopedic- and spine-specific CPT coding nuances.
Knowledge of documentation requirements for Evaluation and Management services.
Excellent organization skills and attention to detail.
Ability to multitask and work in a fast-paced, results-driven position.

Nice To Haves

Experience with orthopedic or multi-specialty groups.
COSC specialty certification (AAPC).
Experience working in a high-volume orthopedic or spine practice.
Exposure to vendor-managed revenue cycle management environments.
Familiarity with systems such as ModMed or athenahealth.

Responsibilities

Code high-complexity orthopedic and neurosurgical procedures, verifying that documentation is complete and compliant.
Assign codes for reimbursement, research, and regulatory compliance using applicable guidelines and coding conventions.
Accurately assign CPT codes, including add-on codes and modifiers, and apply bundling rules and ICD-10 diagnoses supporting medical necessity.
Validate procedure levels, laterality, approach, instrumentation, and graft usage; identify missed billable components such as additional levels, hardware, and biologics.
Query providers for clarification when documentation is unclear, unspecified, missing, or incomplete.
Apply payer-specific coding rules and edits.
Review coding-related denials involving medical necessity, bundling, and documentation; conduct root-cause analysis and identify trends.
Recommend and facilitate corrective actions to prevent future coding errors, and develop coding edits and pre-bill review processes for high-risk procedures.
Conduct targeted pre-bill audits of high-dollar orthopedic surgeries and multi-level or complex cases, ensuring documentation supports medical necessity and procedure specificity; escalate gaps before claim submission.
Partner with surgeons to improve documentation quality and provide case-based feedback on missing elements, procedure complexity, modifier usage, levels, implants, and approach.
Audit external coding vendor performance when applicable, identify coding discrepancies, provide feedback, and uphold coding standards.
Support the development of standard operating procedures and coding guidelines; serve as the primary point of contact between providers and vendors.
Support appeals for coding-related denials by providing coding rationale and validating documentation; partner with accounts receivable teams on high-value accounts.
Administer and uphold company values, policies, and procedures; work toward the company’s goals and vision; perform other duties as assigned.