Coding & Reimbursement Specialist

Specialty Orthopedic Group•Tupelo, MS

About The Position

The Coding & Reimbursement Specialist plays a critical part in protecting revenue integrity while ensuring coding accuracy aligns with payer guidelines, regulatory requirements, and SOG’s standards of excellence. The ideal candidate combines technical coding expertise with strong analytical skills and a proactive, solution-focused mindset.

Requirements

CPS, RHIT, CCS
3+ years of medical coding experience (orthopedics highly preferred).
Strong knowledge of CPT, ICD-10, HCPCS, and modifier usage.
Experience with EHR and practice management systems.
Familiarity with Medicare, Medicaid, and commercial payer policies.
High attention to detail and accuracy
Strong analytical and problem-solving skills
Ability to interpret payer guidelines and apply them appropriately
Professional communication with providers and staff
Commitment to compliance and ethical billing practices
Team-oriented with a proactive mindset

Nice To Haves

Orthopedic coding experience strongly preferred.

Responsibilities

Review and assign accurate CPT, HCPCS, and ICD-10 codes for orthopedic clinic encounters, procedures, injections, DME, imaging, and ancillary services.
Ensure appropriate modifier usage (e.g., -25, -59, -LT/RT, etc.).
Validate documentation supports coded services and query providers when clarification is needed.
Maintain up-to-date knowledge of specialty-specific coding changes.
Perform daily charge review to ensure completeness and accuracy prior to claim submission.
Identify undercoding, overcoding, and missed charge opportunities.
Monitor edits and scrub claims for compliance and clean claim submission.
Collaborate with clinical teams to improve documentation supporting billable services.
Analyze coding-related denials and develop corrective action plans.
Submit corrected claims and appeals as appropriate.
Track payer trends and communicate recurring issues to leadership.
Assist with payer audits and documentation requests.
Ensure adherence to CMS, commercial payer, and state-specific billing regulations.
Participate in internal audits and compliance reviews.
Provide coding education and feedback to providers and clinical staff.
Support annual coding updates and implementation of regulatory changes.
Generate and review coding accuracy and reimbursement reports.
Monitor RVU capture and reimbursement trends.
Assist leadership with benchmarking and payer mix analysis.