Job Requisition: Orthopedic Coding Specialist
Job Title
Orthopedic Coding Specialist (Professional Fee)
Department
Coding Operations
Position Summary
The Orthopedic Coding Specialist is responsible for accurately reviewing, assigning, and validating diagnosis and procedure codes for orthopedic services. This position ensures compliance with ICD-10-CM, CPT, HCPCS Level II, and payer-specific guidelines while supporting accurate reimbursement, regulatory compliance, and quality reporting initiatives. The coder will work closely with providers, auditors, clinical staff, and revenue cycle teams to ensure complete and compliant documentation.
Key Responsibilities
- Review and assign ICD-10-CM, CPT, and HCPCS codes for orthopedic surgical and non-surgical encounters.
- Code complex orthopedic procedures including:
- Joint replacement and revision surgeries
- Arthroscopy procedures
- Fracture care and trauma cases
- Spine procedures
- Sports medicine procedures
- Hand and upper extremity surgeries
- Foot and ankle procedures
- Apply National Correct Coding Initiative (NCCI) edits and payer-specific guidelines.
- Review operative reports, clinic notes, and ancillary documentation for coding accuracy.
- Query providers when documentation clarification is required.
- Monitor coding edits, denials, and reimbursement trends.
- Participate in coding audits and quality improvement initiatives.
- Assist with education related to coding changes and documentation requirements.
- Maintain productivity and quality standards as established by the organization.
Required Qualifications
- High School Diploma or GED required.
- Minimum of 5-6 years of orthopedic coding experience.
- Strong knowledge of:
- ICD-10-CM
- CPT
- HCPCS Level II
- CMS guidelines
- NCCI edits
- Orthopedic anatomy and physiology
- Experience coding operative reports and orthopedic surgeries.
- Proficiency with EHR and encoder software.
Preferred Qualifications
- Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, or related field.
- Experience with academic medical centers or large multi-specialty physician practices.
- Familiarity with risk adjustment and quality reporting programs.
- Previous auditing or education experience.
Required Certifications
One or more of the following:
- Certified Professional Coder (CPC)
- Certified Coding Specialist (CCS)
Knowledge, Skills, and Abilities
- Extensive knowledge of orthopedic procedures and terminology.
- Strong analytical and problem-solving skills.
- Excellent attention to detail.
- Ability to work independently and manage competing priorities.
- Strong written and verbal communication skills.
- Proficient in Microsoft Office applications.
Performance Metrics
- Coding accuracy ≥ 95%
- Productivity standards met or exceeded
- Timely completion of assigned work queues
- Compliance with regulatory and payer requirements
- Reduction in coding-related denials
