• Review provider documentation from office visits, surgeries, imaging interpretations, injections, and other orthopedic services. • Assign appropriate ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes according to official coding guidelines and payer rules. • Verify coding accuracy and completeness to support correct claim submission and reduce denials. • Query providers when documentation is incomplete, unclear, or inconsistent with coding guidelines. • Keep current with orthopedic coding updates, payer policy changes, and compliance regulations. • Collaborate with the billing team to resolve claim rejections, denials, and coding-related issues. • Maintain confidentiality of patient information in compliance with HIPAA regulations. • Participate in coding audits and provide feedback to improve documentation and coding accuracy. • Assist in educating providers and staff on documentation improvement related to orthopedic coding.

• The Medical Coder is responsible for independently reviewing, analysing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. • This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. • The Medical Coder works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. • This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment. • Averages 10 front-end holds per hour • Maintains a minimum of 90% coding accuracy. • Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment. • Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses. • Ensures all diagnosis codes meet local and national medical necessity guidelines. • Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services. • Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality. • Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices. • Independently reviews and resolves all assigned front-end claim holds. • Actively participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead. • Escalates identified client trends to the assigned Coding Team Lead. • Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification. • Maintains and completes all CEU requirements. • Performs other duties or tasks as assigned.

• The Medical Coder is responsible for independently reviewing, analysing, and resolving all assigned front-end claims to ensure accurate and timely claim submission. • This position focuses on identifying and correcting coding-related issues prior to claim transmission, applying established coding guidelines, payer requirements, and organizational policies. • The Medical Coder works closely with revenue cycle partners to prevent claim rejections, support clean claim rates, and promote efficient reimbursement processes. • This role requires strong attention to detail, foundational coding knowledge, and the ability to work independently in a fast-paced environment. • Averages 10 front-end holds per hour. • Maintains a minimum of 90% coding accuracy. • Assigns ICD-10-CM and CPT codes with appropriate modifiers for services provided in the professional fee environment. • Reviews medical records and all applicable documentation to determine appropriate codes for documented services and diagnoses. • Ensures all diagnosis codes meet local and national medical necessity guidelines. • Utilizes internal coding resources, payer guidelines, and other reference materials to ensure accurate and compliant coding for all assigned services. • Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality. • Maintains current knowledge of laws, regulations, payer policies, and industry guidance impacting compliant coding practices. • Independently reviews and resolves all assigned front-end claim holds. • Actively participates in department meetings, one-on-one meetings, and mentorship meetings with the assigned Coding Team Lead. • Escalates identified client trends to the assigned Coding Team Lead. • Escalates all coding-related questions to the assigned Coding Team Lead for guidance and clarification. • Maintains and completes all CEU requirements. • Performs other duties or tasks as assigned.

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company • Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements. • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives. • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager. • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I • Other duties as assigned