Surgery Coder

Role & responsibilities

• Assign Procedure Codes

  Analyze operative reports and surgical note documentation to accurately assign CPT, HCPCS, ICD10CM, and inpatient ICD10PCS codes (with modifiers) to ensure compliant and optimized billing MedEvolve+15The College of Health Care

• Review and Audit Documentation

  Audit surgeon notes and supporting clinical records for completeness, specificity, and alignment with coding standards, resolving coding gaps and ensuring accurate reimbursement

• Claims Preparation & Submission

  Integrate surgical charge capture into claims, verify pre-authorizations and insurance eligibility, then submit claims following RCM protocols to support revenue maximization The College of Health Care Professions.

• Denial Management & Reconciliation

  Monitor claim rejections/denials, perform root-cause analysis, correct coding issues, resubmit claims, and reconcile payments to maintain clean accounts receivable PMC+11

• Provider & Team Collaboration

  Work closely with surgeons, clinical staff, and RCM/billing teams to clarify documentation, drive clinical documentation improvement (CDI), and stay up-to-date on coding rules and payer guidelines

• Reporting & Quality Assurance

  Maintain productivity and quality standards with coding benchmarks, track KPIs (e.g. error rates, turnaround times), participate in audits, and produce reports to inform revenue cycle optimization

Preferred candidate profile

• Hands-on surgical coding expertise

• At least 24 years of experience accurately coding surgical cases (inpatient and/or outpatient), using CPT, ICD10CM, ICD10PCS, HCPCS, and applying appropriate modifiers.
  
• Demonstrated track record of 95% accuracy and coded volume consistent with productivity benchmarks
  

• Certified and thorough knowledge of coding guidelines

• Holds CPC and/or CCS credential (AAPC or AHIMA), with specialty coding certifications (e.g., CPMA, CIRCC) considered a plus
• Strong familiarity with payer-specific rules (e.g. CMS, Medicare/Medicaid), denial management processes, clinical documentation improvement, and regulatory compliance
  

• Analytical, collaborative, and tech-savvy

• Demonstrated analytical skills: ability to audit documentation, identify coding inconsistencies, perform root-cause denial analysis, and recommend process/coding improvements
  
• Effective communicator, adept at querying providers for documentation clarification, and comfortable using EHR/encoder tools (e.g., Epic) and RCM workflows

kaaviya.uppliraja@firstsource.com