Orthopaedic Coding & Precertification Lead

BOSM Management Service Company LLC; Chamblee (GA); On-site; USD 95,000 - 130,000; Full time

Benefits offered by this job

Bonus potential

Comprehensive benefits

Job summary

Barbour Orthopaedics & Spine seeks a strategic Revenue Cycle Leader to optimize orthopedic coding, precertification, and denial prevention across physician practices and ambulatory surgery centers. The role partners with surgeons, ASC leadership, and finance to drive measurable improvements.

The candidate will lead coding teams, ensure payer alignment, and develop efficient authorization processes to enhance patient access and reimbursement outcomes while maintaining regulatory compliance.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or related field preferred; equivalence considered.
• Minimum of five (5) years of orthopedic coding, revenue cycle, authorization, or related healthcare reimbursement experience.
• Minimum of two (2) years of leadership, management, or supervisory experience.
• Strong knowledge of orthopedic surgical coding, precertification processes, payer authorization requirements, and revenue cycle operations.
• Advanced knowledge of CPT, HCPCS, ICD-10-CM, modifier usage, medical necessity requirements, NCCI edits, and global surgery rules.
• Experience managing coding audits, authorization workflows, denials, appeals, and reimbursement-related processes.
• Proficiency with Microsoft Excel and healthcare billing, reporting, PM/EHR systems.

Responsibilities

• Lead orthopaedic coding excellence across joint replacement, sports, spine, and related services.
• Maintain compliance with CPT, HCPCS, ICD-10-CM, CMS, NCCI, and payer requirements.
• Oversee surgical authorizations and precertification workflows to prevent delays.
• Improve clean claim rates and reduce reimbursement delays in collaboration with billing teams.
• Develop and lead high-performing coding and precertification teams.
• Lead appeals and denials management with focus on medical necessity and bundling.
• Monitor KPIs and prepare executive reports on denial trends and reimbursement outcomes.

Skills

Orthopedic coding expertise

Revenue cycle leadership

Payer authorization knowledge

Leadership/management experience

Analytical & data-driven

Communication skills

Education

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or related field

Tools

Microsoft Excel

Power BI

Epic

NextGen

athenahealth

eClinicalWorks

Job description

Barbour Orthopaedics & Spine seeks a strategic Revenue Cycle Leader to optimize orthopedic coding, precertification, and denial prevention across physician practices and ambulatory surgery centers. The role partners with surgeons, ASC leadership, and finance to drive measurable improvements.

The candidate will lead coding teams, ensure payer alignment, and develop efficient authorization processes to enhance patient access and reimbursement outcomes while maintaining regulatory compliance.