Certified Coding Specialist

Spire Orthopedic Partners•Stamford, CT

23d•$26 - $40•Onsite

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. It also includes pre-bill quality reviews, coding-related denial analysis and appeals support, and oversight of external coding vendor quality when applicable. The position is full-time, experienced-level, and based at MSO Corporate 1000 in Stamford, Connecticut. It is a day-shift role with no travel indicated.

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 organizational skills; attention to detail and ability to multitask.
Ability to work in a fast-paced, results-driven position.

Nice To Haves

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

Responsibilities

Code high-complexity orthopedic and neurosurgical procedures across care settings.
Verify that documentation is complete and compliant, and assign codes for reimbursement, research, and regulatory compliance using applicable guidelines.
Apply coding conventions and accurately assign CPT codes, including add-on codes and modifiers, bundling rules, and ICD-10 diagnoses supporting medical necessity.
Validate 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.
Research and analyze coding-related denials, perform root-cause analysis and trend identification, and recommend and facilitate corrective actions to prevent future errors.
Partner with RCM and vendor teams to implement corrective actions; develop coding edits and pre-bill review processes for high-risk procedures.
Perform targeted pre-bill audits for high-dollar orthopedic surgeries and complex or multi-level 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 coding elements and opportunities to capture procedure complexity.
Support provider education on modifier usage and documentation specificity, including levels, implants, and approach.
Audit external coding vendor performance when applicable, identify coding discrepancies, provide feedback, uphold coding standards, and support development of SOPs and coding guidelines.
Serve as the primary resource and Spire Point of Contact between providers and the vendor.
Support appeals for coding-related denials by providing coding rationale and validating documentation; partner with AR teams on high-value accounts.
Administer and uphold company values, policies, and procedures; work toward company goals and vision; perform other duties as assigned.