Outpatient Surgery, Pre-Authorization Coder

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess clinical documentation and assign CPT, ICD-10-CM, and other relevant codes for outpatient surgical encounters.

• Code outpatient surgical specialties, which include orthopedics, fracture treatments, knee procedures, limb-length discrepancy treatments, clubfoot procedures, osteotomies, Ganz procedures, MAGEC/magnetic rod lengthening procedures, casting procedures, cleft lip and palate surgeries, dental procedures, hand and upper-extremity surgeries, burn laser treatments, skin grafts, lesion excisions, circumcision, and hypospadias surgeries.

• Implement official coding guidelines and adhere to client-specific coding requirements.

• Review accounts that have been returned or queried in the assigned coding queue.

• Elevate documentation inquiries or coding issues through established client protocols.

• Uphold productivity, accuracy, and turnaround time expectations.

• Analyze clinical and procedural documentation to ascertain CPT and related procedure codes necessary for pre-authorization workflows.

• Handle an average of 50 pre-authorization cases daily, adjusting for varying volume.

• Assist with routine and priority/STAT requests.

• Identify cases that need further procedural clarification and liaise with designated care managers.

• Track pending cases and follow up once documentation is available.

• Record coding-related notes and follow-up actions in the client system.

• Adhere to client-specific protocols for alternative or multiple procedure codes.

• Engage in onboarding and knowledge transfer with current client personnel.

• Familiarize with client-specific workflows, conventions, documentation needs, and escalation procedures.

• Collaborate with the client’s Coding Supervisor and coding team.

• Support operational continuity during staffing transitions.

• Maintain communication regarding documentation deficiencies, workflow issues, and obstacles to timely coding.

• Not accountable for medical necessity determinations, routine payer policy or coverage research, acquiring payer authorization, managing the complete authorization lifecycle, routine queue administration/reassignment, or conducting routine internal coding audits.

⛳️ Requirements

• At least 3 years of recent experience in outpatient surgery coding is preferred.

• Proven experience in assigning CPT and ICD-10-CM codes for intricate outpatient surgical services.

• Comprehensive understanding of CPT guidelines, surgical coding conventions, and outpatient coding standards.

• Orthopedic surgical coding experience is strongly preferred.

• Familiarity with multiple surgical specialties is highly desirable.

• Previous experience in supporting pre-authorization or pre-service coding workflows is preferred but not mandatory.

• Competence in interpreting operative notes and other clinical documentation accurately and efficiently.

• Exceptional attention to detail and demonstrated coding precision.

• Capability to work autonomously within established workflows while effectively communicating with coding leadership and clinical teams.

• Comfortable operating in a production-based remote coding environment.

• One or more nationally recognized coding credentials are preferred, such as CCS, CCS-P, CPC, COC, RHIT, or RHIA.

• Availability to work generally between 7:00 AM and 5:00 PM Eastern Time, based on client operational requirements.

🏝️ Benefits

• Full-time remote position.

• Structured onboarding and knowledge transfer process.

• Collaboration with client coding leadership and clinical teams.