Medical Coding Specialist

Ortho Sport and Spine Physicians•Atlanta, GA

2d•Onsite

About The Position

Ortho Sport & Spine Physicians is seeking an experienced, highly detail-oriented Medical Coding Specialist to join our growing team. This position is responsible for reviewing clinical documentation, accurately assigning diagnosis and procedure codes, ensuring coding compliance, and supporting accurate and timely claims submission and reimbursement. The ideal candidate will have strong outpatient E/M and orthopedic coding experience, a thorough understanding of current CPT, ICD-10-CM, and HCPCS guidelines, and the ability to independently review documentation and determine the appropriate level of service.

Requirements

Previous professional medical coding experience, preferably in an outpatient physician practice.
Strong knowledge of ICD-10-CM, CPT, and HCPCS.
Strong knowledge of current outpatient E/M coding guidelines, including MDM and time-based code selection.
Demonstrated understanding of medical necessity and documentation requirements.
Knowledge of modifier usage, NCCI edits, bundling, and global surgical periods.
Ability to independently interpret clinical documentation and translate it into accurate medical codes.
Strong attention to detail and ability to identify coding discrepancies.
Excellent analytical, organizational, and problem-solving skills.
Ability to work independently while meeting productivity and accuracy expectations.
Strong written and verbal communication skills.

Nice To Haves

CPC certification through AAPC or an AHIMA coding certification such as CCS or CCS-P.
Hands-on experience with eClinicalWorks (eCW).
Previous orthopedic coding experience.
Experience with orthopedic surgery and/or outpatient procedural coding.
Experience with coding audits, claim review, denial management, or Revenue Cycle operations.
Experience working with Medicare, Medicaid, and commercial insurance plans.

Responsibilities

Review provider documentation, medical records, operative reports, and clinical notes to accurately assign ICD-10-CM, CPT, and HCPCS codes.
Assign diagnosis codes based on documented clinical conditions, medical necessity, and applicable coding guidelines.
Accurately code office visits, procedures, injections, diagnostic services, orthopedic services, and applicable surgical services.
Review documentation for completeness, specificity, and coding accuracy prior to claim submission.
Identify missing, conflicting, or insufficient documentation and communicate with providers or clinical staff for clarification.
Ensure codes accurately reflect the services provided and are supported by the medical record.
Apply appropriate modifiers, including -25, -24, -57, -59, -58, -78, and -79, when supported by documentation and payer guidelines.
Apply appropriate bundling rules, NCCI edits, global surgical periods, medical necessity requirements, and payer-specific coding guidelines.
Review and correct coding-related claim denials, rejections, and errors when necessary.
Apply current outpatient Evaluation and Management (E/M) guidelines.
Independently determine appropriate E/M levels based on documentation and applicable coding rules.
Evaluate medical decision-making based on problems addressed, data reviewed/analyzed, and risk of patient management.
Apply time-based E/M coding when time is used as the basis for code selection.
Recognize when documentation does not support the level of service selected and communicate concerns appropriately.
Stay current with changes to E/M guidelines and CPT coding requirements.
Apply orthopedic-specific coding knowledge to musculoskeletal diagnoses and procedures.
Code conditions involving injuries, fractures, arthritis, joint disorders, sports injuries, spine conditions, and other musculoskeletal complaints.
Understand coding requirements for injections, aspirations, casting/splinting, fracture care, imaging, and surgical services.
Apply appropriate global surgery rules and distinguish between services included within a global surgical package and separately reportable services.
Apply appropriate laterality, anatomical specificity, encounter requirements, and other orthopedic documentation requirements.
Maintain compliance with CMS, AMA CPT, ICD-10-CM, HCPCS, payer, and organizational coding policies.
Participate in coding audits and quality assurance initiatives.
Research complex coding questions using authoritative resources.
Identify coding trends, documentation deficiencies, and opportunities for improvement.
Maintain strict compliance with HIPAA and patient confidentiality requirements.
Work collaboratively with providers and Revenue Cycle staff to improve coding accuracy, clean claim rates, and reimbursement.
Assist with provider coding and documentation education when needed.