Job DetailsLevel: ExperiencedJob Location: MSO Corporate 1000 - Stamford, CT 06905Position Type: Full TimeEducation Level: High School or EquivalentSalary Range: $31.95 - $39.95 HourlyTravel Percentage: NoneJob Shift: DayJob Category: Health CareWhat 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
QualificationsWho 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.
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
QualificationsWho 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.
Job ID: 522941976
Originally Posted on: 5/29/2026
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