Certified Medical Coder - Surgical Services

Essential Duties and Responsibilities

• Accurately assign CPT, ICD-10-CM, and HCPCS Level II codes for professional surgical services based on thorough medical record review.
• Evaluate medical records for proper code assignment, completeness, accuracy, and support of medical necessity.
• Ensure coding compliance with CMS, commercial payer, and regulatory guidelines.
• Identify and address undercoding, overcoding, modifier misuse, and unbundling issues.
• Apply appropriate modifiers and ensure correct provider, place of service, and payer selection.
• Conduct claim review to support clean claim submission and reduce denials.
• Audit coding accuracy through ad hoc reports, focused reviews, and special projects.
• Analyze coding-related denials and recommend corrective actions.
• Review payer policies and stay current on annual coding updates and regulatory changes.
• Collaborate with providers and operational leadership to clarify documentation and improve coding specificity.
• Maintain productivity and quality benchmarks established by the department.
• Serve as a subject matter resource for surgical coding guidance within assigned service lines.

Qualifications

• High-level knowledge of general surgery-related medical terminology, anatomy, and pathophysiology.
• Strong understanding of CPT procedure coding, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis coding.
• Knowledge of coding in surgical practices, ambulatory surgery centers, and hospital settings.
• Ability to evaluate documentation for medical necessity and coding compliance.
• Strong understanding of National Correct Coding Initiative (NCCI) edits and bundling guidelines.
• Ability to audit reports, conduct focused reviews, and participate in special projects.
• Advanced analytical and problem-solving skills.
• High attention to detail and accuracy.
• Proficiency with EHR systems, practice management systems, and claim scrubber tools.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities and meet deadlines.
• Proficiency in Microsoft Office applications.

Education / Experience

• Required: High school diploma or equivalent.
• Minimum five (5) years of professional medical coding experience.
• Strong surgical coding experience required.
• Active coding certification through: American Academy of Professional Coders (AAPC) (ie. CPC), or American Health Information Management Association (AHIMA) (ie. CCS).
• PREFERRED: Certified Professional Medical Auditor (CPMA) through AAPC.
• Experience conducting internal coding audits.
• Experience with CMS Part B and commercial payer reimbursement methodologies.

Physical Demands

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus.
• While performing the duties of this job, the employee is regularly required to talk and hear.
• Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms.
• Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to remaining seated for periods of time to perform computer-based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.).
• Occasionally lift and/or move up to 20-25 pounds.
• Fine hand manipulation (keyboarding).

Work Environment

• Corporate office: 4835 Lyndon B Johnson Fwy, Dallas, TX 75244.
• Remote candidates must reside in a state IES operates in: Arizona, Colorado, Oklahoma, Texas, Alabama, Indiana, Missouri, South Carolina, & Florida.

Travel

• Limited travel may be required as business needs dictate.