EXCELSIOR ORTHOPAEDICS

Medical Billing and Coding

• Review physician documentation, operative reports, and clinical records to assign appropriate diagnosis and procedure codes for orthopedic services, including office visits, imaging, physical therapy, and surgical procedures.
• Ensure practices meet federal and state regulations, payer requirements, and internal policies.
• Collaborate with providers and clinical staff to clarify documentation and support accuracy.
• Monitor edits, denials, and rejections, and assist with corrections and follow-up as needed.
• Partner with the billing team to help resolve discrepancies and support clean claim submission.
• Stay current with coding guidelines, regulatory updates, and payer changes relevant to orthopedic services.
• Accurately enter charge data and maintain complete, compliant documentation.
• Assist with reviewing and assigning CPT, ICD-10, and HCPCS codes based on provider documentation.
• Perform additional responsibilities as assigned.

Coding Specialist – Orthopedic Services

• The Coder is responsible for reviewing, interpreting, and assigning appropriate CPT, ICD-10, and HCPCS codes, and ensuring compliance with federal regulations and payer policies.
• This position is responsible for reviewing operative reports for all procedures performed by Excelsior Orthopaedic Physicians for completeness and to abstract and code clinical data, using standard classification systems.
• Demonstrate our core values of being patient centered, team focused, service driven, accountable, and innovative every day.
• Review and audit physician documentation and surgical reports to accurately assign diagnosis and procedure codes for orthopedic services, including office visits, imaging, physical therapy, and surgical procedures.
• Ensuring coding practice meets federal and state guidelines, payer-specific requirements, and company policies.
• Communicate with providers and clinical staff to ensure accurate documentation to produce accurate coding.
• Monitor coding edits, denials, and rejections; assist in appeals and corrections as needed.
• Collaborate with the billing team to resolve coding and reimbursement issues.
• Stay current with coding guidelines, orthopedic-specific regulations, and payer updates.
• Accurately enter and itemize charge data into the billing system, ensuring completeness and adherence to internal policies.
• Assist with verifying and applying correct CPT, ICD-10, and HCPCS codes based on provider documentation; escalate complex coding issues to certified coders when needed.
• Prepare, process, and transmit insurance claims (electronic and paper) in accordance with payer requirements and deadlines.
• Collect and verify all the information necessary to complete the billing process, including patient demographics, insurance coverage, and provider charge details.
• Evolve in your role when performing supplemental responsibilities as assigned.

Coding Specialist – Orthopedic Services

Certified Medical Coder