Certified Professional Coder - Orthopedics

POSITION OVERVIEW

The Certified Professional Coder (CPC) – Orthopedics is responsible for reviewing clinical documentation and accurately assigning CPT, ICD-10, and HCPCS codes and modifiers for orthopedic procedures, services, and diagnoses to ensure proper billing and compliance with regulatory requirements. This position requires advanced knowledge of orthopedic terminology, coding guidelines, and insurance payer policies. Working closely with orthopedic physicians, clinical staff, and the billing department, the CPC ensures accurate documentation and coding practices that support optimal reimbursement and adherence to payer guidelines.

ESSENTIAL FUNCTIONS INCLUDE, BUT ARE NOT LIMITED TO

• Review and analyze orthopedic clinical documentation to assign appropriate ICD-10-CM, CPT, and HCPCS codes.
• Ensure coding compliance with federal regulations, payer policies, and organizational standards.
• Collaborate with orthopedic providers to clarify documentation and ensure complete, accurate coding.
• Ensure progress notes are coded accurately and to the maximum level of specificity following established coding guidelines.
• Audit and verify codes for accuracy prior to claim submission to reduce denials and improve revenue cycle performance.
• Monitor and stay current with updates to coding guidelines, payer rules, and orthopedic-specific coding practices.
• Assist with training and educating physicians and staff on documentation improvement and coding requirements.
• Respond to coding-related inquiries from billing and administrative staff.
• Participate in internal and external audits and support quality assurance processes.
• Utilize electronic health records (EHR) and practice management systems for code entry and data retrieval.
• Performs other duties as assigned.

MINIMUM REQUIREMENTS / QUALIFICATIONS

• Current Certified Professional Coder (CPC) credential from AAPC or equivalent coding certification (e.g., CCS, COC).
• Minimum of 2 years of medical coding experience, with at least 1 year in orthopedic coding preferred.
• High school diploma or GED required; associate degree in health information management or related field preferred.
• Proficiency with coding software, EHR systems, and Microsoft Office Suite.
• Strong understanding of medical terminology, anatomy & physiology, and orthopedic surgical procedures.
• Proficient Microsoft Office skills

KEY CHARACTERISTICS

• Team Player: Ability to work co-operatively and collaboratively with all levels of employees, management, and external customers to maximize performance and problem solving
• Integrity & Accountability: Unwavering commitment to doing what is right and upholding ethical standards. Takes ownership of tasks and maintains thorough documentation.
• Confidential & Compliant: Maintains confidentiality and complies with all regulatory and privacy standards.
• Detail-Oriented: Maintains precision in documentation, auditing, and policy development.
• Analytical Thinking: Capable of interpreting complex medical notes and determining the most appropriate codes.
• Self-Motivation: Works independently with minimal supervision while managing multiple tasks efficiently.
• Adaptability: Stays updated with changes in coding practices and healthcare regulations.
• Effective Communicator: Excellent communication skills, both verbal and written. Effectively communicates with internal teams and external payers.

PHYSICAL REQUIREMENTS

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

• 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.
• 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.)
• Frequently required to stand, walk, sit, use hands to feel, and reach with hand and arms
• Occasionally lift and/or move up to 20-25 pounds.
• Fine hand manipulation (keyboarding).
• Travel to existing or new OCP locations may be required.