Coder II

OrthoVirginia•Remote VA, VA

2d•$21 - $31

About The Position

The Coder II is a coding professional who reviews and validates complex clinical documentation and coding assignments, with a preferred focus on orthopedic and surgical procedures. The role requires advanced knowledge of coding guidelines, payer policies, and surgical terminology. It helps ensure coding accuracy, regulatory compliance, and optimal reimbursement, while serving as a resource for junior coders and contributing to revenue cycle process improvement.

Requirements

Active CPC, CCS, or equivalent coding credential in good standing.
Minimum of 3 years of professional coding experience, with demonstrated expertise in orthopedic and surgical coding.
High school diploma or equivalent.
Advanced understanding of anatomy, medical terminology, and surgical procedures across orthopedic and related specialties.
Proficiency with electronic health record (EHR) systems and coding software.

Nice To Haves

Associate degree or higher in health information management or a related field.
Strong working knowledge of Microsoft Office products, especially Word, Excel, and Teams.
Ability to interpret complex clinical documentation and apply nuanced coding guidelines with precision.
High level of attention to detail, critical thinking, and problem-solving skills.
Familiarity with payer-specific rules, inclusive billing practices, and appeals processes.
Effective communication and collaboration skills across multidisciplinary teams.
Commitment to professional development and staying current with industry changes and regulatory updates.

Responsibilities

Review clinical documentation and diagnostic results to assign accurate ICD-10-CM and CPT codes.
Code outpatient services, including diagnostics, recurring visits, and procedures performed in orthopedic settings.
Ensure coding supports reimbursement, medical necessity, and regulatory compliance.
Collaborate with providers and clinical staff to clarify documentation and resolve coding discrepancies.
Monitor payer-specific authorization requirements and support appeals when authorizations are not obtained timely.
Submit appeals with supporting documentation when oversights occur, requesting reconsideration based on medical necessity.
Understand payer contracts and recognize limitations in appeal success due to provider-side authorization delays.
Maintain up-to-date knowledge of coding guidelines, payer policies, and regulatory changes.
Contribute accurate reporting for morbidity, mortality, research, and statistical analysis.
Participate in meetings and training sessions to support continuous improvement and compliance.
Mentor or serve as a resource to Coder I team members by offering guidance on complex coding scenarios and best practices.
Maintain thorough documentation of coding activity and adhere to departmental standards for timeliness and accuracy.