Certified Senior Surgical Coder – Revenue Cycle Management

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.

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 coding decision making, compiling appropriate physician education, and physician queries.
• Skills:
  • Strong proficiency in compiling appropriate physician education, and physician queries on surgical cases.
  • Ability to make complex surgical coding decisions utilizing coding guidelines, research, and analytical skills based on recognized coding references and organizational standards.
  • Proficiency in Microsoft Office Suite: intermediate to advanced Excel skill level.
  • Proficiency in coding software and electronic health record (EHR) systems.
• Soft Skills:
  • A self-starter with strong initiative and ability to identify and address potential issues before they arise.
  • Exceptional analytical, organizational, and problem-solving abilities.
  • Strong communication and interpersonal skills for working with diverse teams.
  • Ability to prioritize tasks and meet deadlines in a fast-paced environment.

This is an exempt position. The base compensation range for this role is $65,000 - $89,000.  At VillageMD, compensation is based on several factors including but not limited to education, work experience, certifications, location, etc.  The selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan

Total Rewards at VillageMD

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families.  Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Equal Opportunity Employer

Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

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