Coder - Professional

Advantum Health Private Limited · Healthcare & Pharma

Hyderabad, India
On-site
Posted today
Software Engineering

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About the job

Experience: 5

Job Requisition: Orthopedic Coding Specialist

Job Title

Orthopedic Coding Specialist (Professional Fee)

Department

Coding Operations

Position Summary

The Orthopedic Coding Specialist is responsible for accurately reviewing, assigning, and validating diagnosis and procedure codes for orthopedic services. This position ensures compliance with ICD-10-CM, CPT, HCPCS Level II, and payer-specific guidelines while supporting accurate reimbursement, regulatory compliance, and quality reporting initiatives. The coder will work closely with providers, auditors, clinical staff, and revenue cycle teams to ensure complete and compliant documentation.

Key Responsibilities

Review and assign ICD-10-CM, CPT, and HCPCS codes for orthopedic surgical and non-surgical encounters.

Code complex orthopedic procedures including: - Joint replacement and revision surgeries

Arthroscopy procedures

Fracture care and trauma cases

Spine procedures

Sports medicine procedures

Hand and upper extremity surgeries

Foot and ankle procedures

Apply National Correct Coding Initiative (NCCI) edits and payer-specific guidelines.

Review operative reports, clinic notes, and ancillary documentation for coding accuracy.

Query providers when documentation clarification is required.

Monitor coding edits, denials, and reimbursement trends.

Participate in coding audits and quality improvement initiatives.

Assist with education related to coding changes and documentation requirements.

Maintain productivity and quality standards as established by the organization.

Required Qualifications

High School Diploma or GED required.

Minimum of 5-6 years of orthopedic coding experience .

Strong knowledge of: - ICD-10-CM

CPT

HCPCS Level II

CMS guidelines

NCCI edits

Orthopedic anatomy and physiology

Experience coding operative reports and orthopedic surgeries.

Proficiency with EHR and encoder software.

Preferred Qualifications

Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, or related field.

Experience with academic medical centers or large multi-specialty physician practices.

Familiarity with risk adjustment and quality reporting programs.

Previous auditing or education experience.

Required Certifications

One or more of the following:

Certified Professional Coder (CPC)

Certified Coding Specialist (CCS)

Knowledge, Skills, and Abilities

Extensive knowledge of orthopedic procedures and terminology.

Strong analytical and problem-solving skills.

Excellent attention to detail.

Ability to work independently and manage competing priorities.

Strong written and verbal communication skills.

Proficient in Microsoft Office applications.

Performance Metrics

Coding accuracy ≥ 95%

Productivity standards met or exceeded

Timely completion of assigned work queues

Compliance with regulatory and payer requirements

Reduction in coding-related denials

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