[Hiring] Coder II @OrthoVirginia

Role Description

The Coder II is a coding professional responsible for reviewing and validating complex clinical documentation and coding assignments, with a preferred focus on orthopedic and surgical procedures. This role requires advanced knowledge of coding guidelines, payer policies, and surgical terminology, and plays a key part in ensuring coding accuracy, regulatory compliance, and optimal reimbursement. The Coder II also serves as a resource for junior coders and contributes to process improvement initiatives within the revenue cycle team.

• Review clinical documentation and diagnostic results to assign accurate ICD-10-CM and CPT codes.
• Code outpatient services including diagnostics, recurring visits, and procedures performed in orthopedic settings.
• Ensure coding supports reimbursement, medical necessity, and regulatory compliance.
• Collaborate with providers and clinical staff to clarify documentation and resolve coding discrepancies.
• Monitor payer-specific authorization requirements and support appeals when authorizations are not obtained timely.
• Submit appeals with supporting documentation when oversight occurs, requesting reconsideration based on medical necessity.
• Understand payer contracts and recognize limitations in appeal success due to provider-side authorization delays.
• Maintain up-to-date knowledge of coding guidelines, payer policies, and regulatory changes.
• Contribute accurate reporting for morbidity, mortality, research, and statistical analysis.
• Participate in meetings and training sessions to support continuous improvement and compliance.
• Serve as a mentor or resource to Coder I team members, offering guidance on complex coding scenarios and best practices.
• Maintain thorough documentation of coding activity and adhere to departmental standards for timeliness and accuracy.

Qualifications

• Certification: CPC, CCS, or equivalent coding credential (active and in good standing).
• Experience: Minimum 3 years of professional coding experience, with demonstrated expertise in orthopedic and surgical coding.
• Education: High school diploma or equivalent required; associate degree or higher in health information management or related field preferred.
• Advanced understanding of anatomy, medical terminology, and surgical procedures across orthopedic and related specialties.
• Proficiency with electronic health record (EHR) systems and coding software.

Preferred Skills

• Strong working knowledge of Microsoft Office products, especially Word, Excel, and Teams.
• Ability to interpret complex clinical documentation and apply nuanced coding guidelines with precision.
• High level of attention to detail, critical thinking, and problem-solving skills.
• Familiarity with payer-specific rules, inclusive billing practices, and appeals processes.
• Effective communication and collaboration skills across multidisciplinary teams.
• Commitment to professional development and staying current with industry changes and regulatory updates.

Compensation

Compensation Range for this position: $20.96 - $31.44. Compensation for this role will be based on several factors, including the candidate's qualifications, relevant experience, education, skills, certifications, geography/market, and internal equity considerations.

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