Certified Professional Coder in Wilmington, Delaware at Regional Medical Management Services LLC

*Position Summary
The Certified Orthopedic Coder is responsible for accurately assigning ICD-10-CM, CPT, and HCPCS Level II codes for orthopedic-related diagnoses, procedures, and services. This role requires deep knowledge of musculoskeletal anatomy, surgical techniques, and orthopedic subspecialties to ensure compliant coding, optimal reimbursement, and adherence to payer and regulatory guidelines. The coder works closely with physicians, clinical staff, and billing teams to support clean claims, audit readiness, and revenue integrity.

*Key Responsibilities
-Coding & Documentation
-Assign accurate ICD-10-CM, CPT, and HCPCS codes for orthopedic outpatient, inpatient, and surgical services
-Code complex orthopedic procedures including:
~Joint replacements
~Arthroscopy
~Spine procedures
~Fracture care
~Sports medicine procedures
-Ensure coding reflects correct laterality, encounter type, global periods, and modifiers (e.g., -26, -TC, -50, -59, -LT/-RT)

*Compliance & Quality
-Maintain compliance with CMS, AMA, payer-specific, and regulatory coding guidelines
-Participate in internal and external audits; address findings and implement corrective actions
-Stay current with annual coding updates, NCCI edits, LCDs/NCDs, and orthopedic coding trends
-Identify documentation gaps and proactively query providers when clarification is needed

*Collaboration & Support
-Work closely with orthopedic surgeons, APPs, and clinical teams to improve documentation quality
-Support billing and denial management teams by providing coding clarification and appeal support
-Contribute to process improvement initiatives focused on accuracy, efficiency, and compliance

*Productivity & Reporting
-Meet or exceed established productivity and accuracy benchmarks
-Track and report coding issues, trends, and opportunities for improvement
-Assist with onboarding and mentoring junior coders as needed

*Required Qualifications
-Education & Certification
~High school diploma or equivalent required
~Active coding certification, such as:
CPC (AAPC)
CCS (AHIMA)
~Orthopedic coding specialty certification preferred (e.g., COSC)
-Experience
~Minimum 2–3 years of orthopedic-specific coding experience
~Demonstrated experience coding operative reports and complex orthopedic cases
~Experience with EHR and practice management systems
-Preferred Qualifications
~Experience in high-volume orthopedic or multispecialty practices
~Knowledge of both professional and facility coding
~Prior audit or compliance experience
~Familiarity with value-based care and risk adjustment principles
-Skills & Competencies
~Advanced knowledge of musculoskeletal anatomy and orthopedic procedures
~Strong attention to detail with high accuracy standards
~Analytical mindset with the ability to interpret complex clinical documentation
~Excellent written and verbal communication skills
~Ability to work independently while collaborating across departments
~Strong time management and organizational skills

*Work Environment
-Office-based
-Prolonged periods of computer-based work
-Fast-paced, deadline-driven environment requiring sustained accuracy

*Performance Metrics
-Coding accuracy rate
-Productivity benchmarks
-Audit outcomes
-Denial reduction and clean claim rates

*Benefits
-401(k)
-401(k) matching
-Dental insurance
-Dependent care flexible spending account
-Health insurance
-Life insurance
-Paid time off
-Vision insurance