SURGERY CODER - TIER II

Job Description

Job Description

Position Summary:

The Surgery Coder – Tier Two is responsible for reviewing operative reports and assigning accurate CPT, ICD-10-CM, and HCPCS codes for intermediate to complex orthopedic surgical procedures. This role ensures coding compliance with official guidelines and payer-specific rules to support timely and accurate reimbursement. This position requires a solid understanding of orthopedic anatomy, procedures, and documentation requirements. The Tier Two coder works independently with minimal supervision, may assist in mentoring Tier One coders, and supports documentation improvement efforts through collaboration with providers and internal teams.

Full Time (Remote) Monday through Friday Days

Core Values:

• Communication: Verbal and written communications are effective in soliciting and conveying information. Information is clear, concise and timely.
• OrthoAlliance Policies: Consistently adheres to OrthoAlliance Policies and Procedures (i.e.: including but not limited to: appropriate cell phone and computer usage, dress code, etc.). Also follows all OSHA and HIPAA regulations.
• Teamwork: Demonstrates teamwork within department and with company contacts. Allows for flexibility in how work is accomplished. Treats others with respect and dignity.
• Initiative: Takes initiative in routine situations and proceeds when appropriate. Learns new processes, procedures and technology as needed. Makes appropriate decisions.
• Patient Care/Customer Service: Responds to patients and coworkers in a friendly and professional manner. Anticipates patient needs, patients always come first.
• Dependability: Consistent pattern of good attendance and punctuality. Employee can be relied upon to meet work schedule and complete duties.

Core Responsibilities :

• Analyze detailed surgical documentation to extract appropriate CPT, ICD-10-CM, and HCPCS Level II codes for intermediate to complex orthopedic surgical procedures in accordance with official coding guidelines, NCCI edits, and payer policies.
• Identify and appropriately assign surgical modifiers based on documentation and coding conventions.
• In-depth knowledge of surgical anatomy and procedures to assign precise codes.
• Adhere to official coding guidelines, payer policies, NCCI edits, and regulatory requirements.
• Validate charges for completeness and accuracy after claim submission.
• Communicate with surgeons for clarification on documentation or coding discrepancies.
• Collaborate with senior coders, leadership, billing, and accounts receivable to ensure claim accuracy.
• Escalate complex or ambiguous cases to senior coder or leadership for further review.
• Communicate identified trends and opportunities for improvement to leadership.
• Serve as a resource for Tier One coders by answering coding questions and providing peer support when needed.
• Reflect an attitude that is collaborative and supportive to the team and team goals.
• Assist in onboarding and mentoring new orthopedic coders to ensure consistency and accuracy across the team.

Quality & Productivity

• Accuracy Standards: Maintain high coding accuracy (>95%)
• Productivity Metrics : Meet or exceed surgical coding productivity benchmarks
• Ongoing Education : Stay current with coding updates, payer changes, and surgical techniques

Required Skills and Knowledge:

• Knowledge of CPT, ICD-10-CM, and HCPCS Level II coding guidelines, medical terminology, anatomy, and physiology
• Knowledge of official coding guidelines, payer policies, NCCI edits, and regulatory requirements
• Exceptional verbal and written communication skills
• Skilled in using EHRs and coding software like Epic, NextGen, and Select Coder
• Proficiency in Microsoft Office Products (Word, Excel, Outlook, SharePoint, PowerPoint)
• Ability to effectively support a positive team attitude while working remotely
• Maintain confidentiality and protect sensitive data
• Exceptional attention to detail, analytical skills, and ability to work independently in a productivity-driven environment
• Maintain Coding Certification(s)

Education / Experience Required:

• High school diploma or equivalent required
• Credentialed as Certified Professional Coder (CPC) or equivalent certification through AAPC or AHIMA
• Minimum 3-5 years surgical coding experience, including at least 1-2 years in orthopedic surgery coding
• Dual credentialed including orthopedic coding specialty certification (COSC) or auditing certification (CPMA) a plus
• Completion of a coding skills assessment may be required to validate competency and proficiency

Preferred Experience:

• Prior leadership or mentorship experience in a coding team setting
• Background in working with foot & ankle surgeons, hand surgeons, or spine and/or trauma surgeons
• Experience contributing to internal audits, training, and documentation improvement initiatives

Physical Requirements:

Physical requirements for the position include the ability to frequently hear and communicate orally, see up close and at a distance, read and comprehend, stand, sit, walk, reach, handle, and/or feel objects. Must be able to climb, pull, push and kneel. Maximum unassisted lift = 25 lbs. Average lift less than 10 lbs. Must be able to work extended hours as necessary.