About Our Company

We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.

Job Description

We are seeking a detail-oriented and experienced Surgical Specialty Coder who will be a part of the Revenue Cycle Management team.  The surgical specialty coder will be responsible for accurately reviewing and coding surgical procedures and related diagnoses, reviewing and correcting claims that have been denied by the insurance payor for coding related issues, ensuring compliance with all applicable coding standards, regulations, and guidelines, as well as communicating and supporting coding rationales to physicians and leadership. Your expertise in surgical specialties, attention to detail, and understanding of medical terminology will support the financial health of the organization and facilitate accurate reimbursement.

Key Responsibilities

Medical Coding:

• Assign accurate CPT, ICD-10-CM, and HCPCS codes for surgical procedures, diagnoses, and related services.
• Review clinical documentation to ensure coding reflects the services provided.
• Understand and apply surgical coding for a wide range of procedures, including but not limited to arthroplasty, laminectomy, and other spine surgeries.
• Research complex surgical cases utilizing CPT, CMS, AMA and specialty society resources & guidelines with organizational standards.
• Communicate coding rationales, with appropriate supporting references, to leadership and physicians.
• Identify missing documentation and work with providers to obtain necessary information for accurate coding.

Compliance:

• Ensure coding practices comply with federal, state, and payer-specific guidelines.
• Stay updated on coding changes, regulatory requirements, and payer policies.
• Participate in audits and quality reviews to maintain compliance and accuracy.

Collaboration and Communication:

• Collaborate with surgeons, healthcare providers, coding and compliance team and billing staff to clarify documentation and coding requirements.
• Provide feedback and education to providers on documentation improvements to support coding accuracy.

Analysis and Reporting:

• Manipulate and review monthly surgical coding reports for coding accuracy.
• Analyze coding trends and identify opportunities for process improvement.
• Assist in resolving coding-related denials or discrepancies with insurance payers.

Training and Development:

• Maintain certification and participate in ongoing education to enhance coding expertise.
• Assist in training new coders or staff in surgical coding best practices and areas of coding development.

Qualifications and Skills

• Education: High school diploma or equivalent required; associate’s degree in a related field preferred.
• Certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS)
• Experience:
  • Minimum of 3-5 years of coding experience, with a focus on surgical specialties (e.g., Spine Surgery, Orthopedics, General Surgery, etc.).
  • Strong knowledge of anatomy, physiology, and medical terminology specific to surgical procedures.
  • Experience in codi