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• Review operative and/or progress notes to code claims for providers who have A/R support provided by staff not credentialed as CPC.
• Review NCCI edits to code modifiers for surgeries and procedures based on operative and/or progress notes.
• Ensure proper coding of hospital visits, surgeries, physician, physical therapy and occupational therapy visits for providers.
• Review incomplete charge slips identified by other staff members for missing procedures or codes. Provides team members with information needed to complete charge entry.

Education, Experience, and Certification/Licensure Required:

• High School Diploma or equivalent required. Minimum of 3 – 5 years of work experience coding orthopedic surgical cases, preferably including experience with Spine or Trauma subspecialities.  Candidates must have current certification as a Certified Professional Coder, or equivalent, and additional certification specific Orthopedic Coding is preferred. Proficiency with software including practice management systems and Microsoft Excel is required.

  Knowledge, Skills, and Abilities:

  Current AAPC, Certified Professional Coder (CPC) required and/or additional coding as Certified Orthopedic Surgery Coder (COSC), Certified Evaluation and Management Coding (CEMC) desirable; Demonstrates general knowledge of medical terminology and human anatomy; Demonstrates knowledge of medical billing and coding, evidenced by designation of certified professional coder and relevant job experience; Demonstrates knowledge of insurance processes and reimbursement practices; Able to work with high volume of work while maintaining attention to detail and accuracy; Demonstrates excellent oral and written communication skills; Able to operate practice management system and other computer programs (i.e., use Windows operating system, conduct Internet searches, communicate by email, etc.); Able to operate a calculator to accurately perform basic math functions.

  Able to work cooperatively as a member of the billing department to meet the needs of internal and external customers; Able to troubleshoot and resolve problems reported by staff with the practice management system.

  Policies and Procedures:

• Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
• Provides assistance and support to leadership in implementing policies and procedures as necessary.
• Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

• Teamwork:

• Works cooperatively with coworkers, providers, and management.
• Shares knowledge and insights with co-workers in a constructive manner.
• Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.
• Addresses conflicts with person directly before involving manager or uninvolved peers.
• Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.

• Customer Service and Communications:

• Communicates with patients, insurance carriers and other outside entities in a professional manner.  Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc.  Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person.
• Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload.
• Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance.

• Shares Knowledge/Educates:

• Assist leadership in educating billable providers with on proper use of modifiers and other remedial coding instruction.
• Provide support to leadership with team coding audits.
• Develops and coordinates with coding educator and leadership resources and guidelines for specialty coding.
• Monitor team unbilled claims, open superbills, denial trends and coding errors monthly and implement guidelines, billing edits and resources to prevent the untimely billing of claims and denial of the claim.
• Maintain the team code change log process to ensure second or third level review of code changes before sending to provider for validation and approval.
• Reviews various billing sources for orthopedic specific updates and communicates information to the Patient Accounts Department on matters such as insurance guideline changes or precertification requirements.