Certified Coding Specialist

Our take on this role

About this role

Code complex orthopedic and neurosurgical procedures, review documentation, and support coding-related appeals and surgeon documentation improvements. The posting requires CPC, CCS, or equivalent certification and at least five years of surgical coding experience.

What could you bring from clinical work?

• Nurses: Your experience reviewing clinical records and documenting medical necessity could help with validating documentation and providing clinical rationale for coding-related appeals.
• PTs: Documenting orthopedic diagnoses and medical necessity may help you review whether surgical documentation supports medical necessity.
• OTs: If you've reviewed orthopedic records and identified documentation gaps, that experience could help when requesting clarification from surgeons about incomplete documentation.

Full job description from Spire Orthopedic Partners

Job Details: Level: Experienced, Job Location: MSO Corporate 1000 - Stamford, CT, Position Type: Full Time, Education Level: High School or Equivalent, Salary Range: $31.95 - $39.95Hourly, Travel Percentage: None, Job Shift: Day, Job Category: Finance, What you’ll do:

The Certified Coding Specialist is responsible for accurate and compliant coding of complex orthopedic procedures across all care settings. This role directly impacts revenue integrity by ensuring optimal CPT/ICD-10 coding, minimizing denials, and supporting provider’s documentation improvement.

Responsibilities/Duties:

Complex Surgical Coding

Code high-complexity orthopedic and neurosurgical procedures
Verifying all documentation is complete and compliant
Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.
Follows 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

Denial Prevention & Root Cause Ownership

Researches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future coding errors:
Review coding-related denials (medical necessity, bundling, documentation)
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

Pre-Bill Quality Review

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

Provider Documentation Improvement

Partner with surgeons to improve documentation quality
Provide targeted, case-based feedback:
Missing elements impacting coding accuracy
Opportunities to fully capture procedure complexity
Support education on:
Modifier usage
Documentation specificity (levels, implants, approach)

Vendor Oversight & Coding Quality Control

Audit external coding vendor performance (if applicable)
Identify discrepancies between internal and vendor coding
Provide feedback and enforce coding standards
Support development of SOPs and coding guidelines
Serves as primary resource and Spire Point of Contact (SPOC) between provider and vendor

Appeals

Support appeals for coding-related denials
Provide clinical/coding rationale and documentation validation
Partner with AR teams on high-value accounts

Qualifications: Who you are:

Required 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
Administer and uphold all the Company’s values and policies and procedures.
Continuously work towards the Company’s goal and vision.
Performs other duties as assigned.

Preferred Qualifications

COSC specialty certification (AAPC)
Experience working in a high-volume orthopedic/spine practice
Exposure to vendor-managed RCM environments
Familiarity with systems like ModMed or athenahealth

What we offer:

Excellent growth and advancement opportunities
Dynamic environment
Access to a diverse network of practitioners
Broad infrastructure of tools and programs to enhance the employee experience
Competitive Compensation
Generous PTO
Benefits package: health, dental, vision, 401(k), etc.

We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).

The final pay offered to a successful candidate will be dependent on several factors that may include but are not limited to the type and years of experience within the job, the type of years and experience within the industry, education, etc.