Certified Coding Specialist

Responsibilities

• Code high-complexity orthopedic and neurosurgical procedures
• Verify all documentation is complete and compliant
• Assign codes for reimbursements, research, and compliance with regulatory requirements utilizing guidelines
• Follow coding conventions and ensure accurate assignment of: CPT (including add-on codes, modifiers, bundling rules), ICD-10 diagnoses supporting medical necessity
• Validate: Levels, laterality, approach (anterior/posterior), instrumentation and graft usage
• Identify missed billable components (e.g., additional levels, hardware, biologics)
• Query provider for any necessary clarification related to unclear, unspecified or missing/incomplete documentation
• Apply payer-specific coding rules and edits
• Prevent and own root cause of coding errors by researching, analyzing, recommending, and facilitating a plan of action to correct discrepancies and prevent future coding errors
• Perform root cause analysis and trend identification
• Partner with RCM and vendor teams to implement corrective actions
• Develop coding edits and pre-bill review processes for high-risk procedures
• Perform targeted pre-bill audits for: High-dollar orthopedic surgeries, multi-level and complex cases
• Ensure documentation supports: Medical necessity, procedure specificity, Escalate documentation gaps prior to claim submission
• Partner with surgeons to improve documentation quality
• Provide targeted, case-based feedback: Missing elements impacting coding accuracy
• Support education on: Modifier usage, Documentation specificity (levels, implants, approach)
• Serve as primary resource and Spire Point of Contact (SPOC) between provider and vendor
• Appeals Support: Provide clinical/coding rationale and documentation validation
• Partner with AR teams on high-value accounts

Qualifications

• CPC, CCS, or equivalent certification (AAPC or AHIMA)
• 5+ years of surgical coding experience
• Deep knowledge of: NCCI edits and bundling rules, Modifier usage (e.g., 22, 25, 50, 51, 57, 59, 62, 76), Orthopedic and Spine-specific CPT coding nuances, Documentation requirements for Evaluation and Management services
• Experience with orthopedic or multi-specialty groups preferred
• Excellent organization skills
• Detailed oriented and comfortable with multi-tasking
• Ability to work in face-paced, results driven position