Orthopaedic Coding & Precertification Manager

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

Description

Help Shape the Financial Health of a Growing Orthopaedic Organization

At Barbour Orthopaedics & Spine, we're building one of the premier musculoskeletal care organizations in the Southeast. With a growing network of orthopaedic surgeons, spine specialists, sports medicine physicians, advanced practice providers, ambulatory surgery centers, imaging services, and rehabilitation programs, we are seeking a high-performing to help optimize reimbursement, strengthen compliance, and lead our coding and authorization operations.

This is an opportunity for a revenue cycle leader who understands the complexities of orthopaedic surgery, outpatient coding, payer authorizations, and ASC operations, and who thrives in a fast-paced, growth-oriented environment.

If you're a Leader with a strong coding background and a passion for improving financial performance while supporting exceptional patient care, we want to hear from you.

Why Join Barbour Orthopaedics & Spine?

• Growing multi-state orthopaedic platform
• Opportunity to lead and build high-performing teams
• Direct impact on revenue cycle performance and organizational growth
• Collaborative partnership with surgeons, executives, and operational leaders
• Competitive compensation, bonus potential, and comprehensive benefits
• Career advancement opportunities within a rapidly expanding organization

Position Summary:

The Orthopaedic Coding & Precertification Manager is responsible for the strategic leadership and day-to-day management of orthopedic coding, surgical precertification, denial prevention, documentation integrity, and revenue optimization initiatives across physician practice and ambulatory surgery center operations.

The ideal candidate combines deep expertise in orthopedic surgical coding, outpatient reimbursement, payer authorization requirements, and revenue cycle operations with proven leadership experience developing high-performing teams and driving measurable financial outcomes.

This role serves as a critical business partner to physicians, ASC leadership, surgery scheduling teams, finance, and revenue cycle stakeholders.

What You'll Do

Lead Orthopaedic Coding Excellence

• Ensure accurate coding of orthopedic procedures, including:
  • Joint Replacement
  • Sports Medicine
  • Arthroscopy
  • Spine Surgery
  • Fracture Care
  • Trauma
  • Injection Procedures
  • Hand and Upper Extremity Services
• Maintain compliance with CPT, HCPCS, ICD-10-CM, CMS, NCCI, and payer requirements.
• Provide coding guidance related to modifier usage, laterality, global surgical packages, and medical necessity requirements.
• Conduct coding audits and provider education programs to improve documentation quality and coding accuracy.

Manage Surgical Authorizations & Precertification

• Oversee all surgical and procedural authorization workflows.
• Ensure timely authorization approvals to prevent surgical delays and avoidable denials.
• Develop efficient authorization processes that improve patient access and reimbursement outcomes.
• Monitor payer-specific requirements and proactively address authorization challenges.

Optimize Revenue Cycle Performance

• Partner with billing teams to improve clean claim rates and reduce reimbursement delays.
• Monitor and resolve:
  • Authorization discrepancies
  • Charge lag
  • Coding edits
  • Clearinghouse rejections
  • Unbilled claims
• Identify and implement opportunities for revenue enhancement and revenue leak prevention.

Reduce Denials & Maximize Reimbursement

• Analyze coding-related and authorization-related denials.
• Develop corrective action plans and sustainable process improvements.
• Lead appeal efforts involving medical necessity, coding compliance, authorization disputes, and bundling issues.
• Present denial trends and financial impact analyses to leadership.

Develop & Lead High-Performing Teams

• Manage coding specialists, precertification coordinators, and revenue cycle team members.
• Establish productivity and quality benchmarks.
• Coach, mentor, and develop staff through training and performance management initiatives.
• Foster a culture of accountability, collaboration, and continuous improvement.

Drive Compliance & Reporting

• Oversee internal coding and authorization audits.
• Maintain compliance with federal and state regulations.
• Monitor key operational and financial KPIs.
• Prepare executive reports related to coding quality, authorization performance, denial trends, and reimbursement outcomes.
• Support quarterly strategic initiatives and departmental goals.

What Makes You Successful

You are:

• A strategic revenue cycle leader who understands both operational and financial impacts.
• Comfortable working directly with surgeons and executive leadership.
• Skilled at interpreting complex payer requirements.
• Passionate about process improvement and operational efficiency.
• Highly analytical and data-driven.
• A collaborative problem solver who can influence change across departments.

Requirements

Minimum Qualifications:

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or related field preferred; equivalent education and experience may be 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.
• Working knowledge of commercial insurance, workers' compensation, and third-party payer requirements.
• Experience managing coding audits, authorization workflows, denials, appeals, and reimbursement-related processes.
• Strong analytical, organizational, problem-solving, and communication skills.
• Proficiency with Microsoft Excel and healthcare billing, reporting, practice management, and electronic health record systems.

Preferred Qualifications:

• Experience in an orthopedic physician practice, multi-location orthopedic organization, ambulatory surgery center (ASC), or high-volume surgical environment.
• Experience with professional fee billing, surgical coding, payer contract analysis, and revenue cycle analytics.
• Experience using Epic, NextGen, athenahealth, eClinicalWorks, or comparable PM/EHR platforms.
• Experience utilizing Power BI or other business intelligence and reporting tools.

Required Certifications and Licensure:

• CPC (Certified Professional Coder)

Preferred Certifications and Licensure

• COCS (Certified Orthopedic Coding Specialist)
• CPMA (Certified Professional Medical Auditor)
• COC (Certified Outpatient Coder)
• CIC (Certified Inpatient Coder)
• CPC-H or equivalent coding certification
• CRCR (Certified Revenue Cycle Representative)
• CPB (Certified Professional Biller)