Outpatient Surgery & Pre-Authorization Coder

About the role

The Outpatient Surgery & Pre-Authorization Coder is responsible for accurate coding of outpatient surgical encounters while also supporting pre-authorization coding through the assignment of appropriate CPT and related procedure codes. This position requires a strong outpatient surgical coding background, the ability to interpret clinical documentation across a variety of surgical specialties, and the flexibility to support both surgical coding and pre-authorization workflows based on operational needs. The role works collaboratively with client coding leadership and clinical teams to maintain timely, accurate coding and efficient queue progression.

Responsibilities

Outpatient Surgery Coding

• Review clinical documentation and accurately assign CPT, ICD-10-CM, and other applicable codes for outpatient surgical encounters.
• Code a variety of outpatient surgical specialties, including:
  • Orthopedics
  • Fracture treatment
  • Knee procedures
  • Limb-length discrepancy procedures
  • Clubfoot procedures
  • Osteotomies
  • Ganz procedures
  • MAGEC/magnetic rod lengthening procedures
  • Casting procedures
  • Cleft lip and palate procedures
  • Dental procedures
  • Hand and upper-extremity procedures
  • Burn laser treatments
  • Skin grafts
  • Lesion excisions
  • Circumcision and hypospadias procedures
• Apply official coding guidelines and client-specific coding requirements consistently.
• Review returned or queried accounts when they become available within the assigned coding queue.
• Escalate documentation questions or coding concerns through established client processes.
• Maintain established productivity, accuracy, and turnaround expectations.

Pre-Authorization Coding

• Review available clinical and procedural documentation to determine appropriate CPT and related procedure codes needed to support the client's pre-authorization workflow.
• Process an average pre-authorization volume of approximately 50 cases per day, recognizing that daily volume may fluctuate.
• Support timely processing of routine and priority/STAT requests.
• Identify cases requiring additional procedural detail before coding can be finalized.
• Communicate with designated care managers when clarification is required.
• Monitor pending cases and return to accounts when additional documentation becomes available.
• Accurately document coding-related notes and follow-up within the client's system.
• Follow established client-specific coding conventions for procedures requiring alternative or multiple codes.

Scope Clarification

• This position is focused on coding support for the pre-authorization process and is not responsible for:
  • Performing medical-necessity determinations.
  • Conducting routine payer-policy or coverage research.
  • Obtaining authorization directly from payers.
  • Managing the complete authorization lifecycle.
  • Routine queue administration or reassignment of work.
  • Routine internal coding audits.

Knowledge Transfer & Collaboration

• Participate in structured onboarding and knowledge transfer with existing client staff.
• Learn client-specific surgical and pre-authorization workflows, coding conventions, documentation requirements, and escalation processes.
• Collaborate closely with the client's Coding Supervisor and coding team.
• Support continuity of operations during staffing transitions.
• Maintain clear communication regarding documentation gaps, workflow concerns, or barriers affecting timely coding.

Requirements

• Minimum of 3 years of recent outpatient surgery coding experience preferred.
• Demonstrated experience assigning CPT and ICD-10-CM codes for complex outpatient surgical services.
• Strong knowledge of CPT guidelines, surgical coding conventions, and outpatient coding requirements.
• Orthopedic surgical coding experience strongly preferred.
• Experience with multiple surgical specialties is highly desirable.
• Previous experience supporting pre-authorization or pre-service coding workflows preferred but not required.
• Ability to interpret operative notes and other clinical documentation accurately and efficiently.
• Strong attention to detail and demonstrated coding accuracy.
• Ability to work independently within established workflows while communicating effectively with coding leadership and clinical teams.
• Comfortable working in a production-based remote coding environment.

Qualifications

One or more nationally recognized coding credentials preferred, such as:

• CCS
• CCS-P
• CPC
• COC
• RHIT
• RHIA

Schedule

• Full-time remote position.
• Expected schedule generally falls between 7:00 AM and 5:00 PM Eastern Time.
• Specific schedule will be established based on client operational needs.
• Start times earlier than 7:00 AM ET are generally not anticipated.