Senior Coding Operations Specialist

The CORE Institute; Phoenix (AZ); Remote; USD 70,000 - 90,000; Full time

Job summary

The CORE Institute is seeking a senior medical coder for a remote role in the United States. The position requires 5+ years of professional medical coding experience, preferably with orthopedic surgical coding, and current AAPC or AHIMA certification.

The candidate will lead complex coding questions, support audits, and drive process improvements across coding workflows while maintaining the highest accuracy and compliance standards.

Qualifications

• 5+ years of professional medical coding experience, preferably orthopedic surgical coding.
• AAPC/AHIMA certification must be maintained.

Responsibilities

• Monitor coding backlogs, turnaround times, unresolved encounters, missing documentation, and workflow exceptions.
• Reconcile coding work queues, surgery schedules, missing slips, EFS/charge capture systems, and other workflows.
• Serve as a senior coding resource for complex procedural, surgical, specialty, and payer-related coding questions.
• Research CPT, ICD-10-CM, HCPCS, NCCI, payer policies, and regulatory guidance.
• Identify coding trends, workflow concerns, documentation issues, and provide recommendations to Coding leadership.

Skills

Analytical skills

Research skills

Organizational skills

Communication skills

Independent work

Job description

ESSENTIAL FUNCTIONS

• Monitor coding backlogs, turnaround times, unresolved encounters, missing documentation, and workflow exceptions.
• Reconcile coding work queues, surgery schedules, missing slips, EFS/charge capture systems, and other applicable workflows.
• Serve as a senior coding resource for complex procedural, surgical, specialty, and payer-related coding questions.
• Research and apply CPT, ICD-10-CM, HCPCS, NCCI, payer policies, and regulatory guidance.
• Identify coding trends, workflow concerns, documentation issues, and areas of risk and provide recommendations to Coding leadership/CDI.
• Support audit trend analysis, root-cause review, and development of corrective education.
• Assist the Coding Manager and Supervisors with special projects, workflow reviews, market needs, and process improvement initiatives.
• Escalate staffing or employee workflow and performance concerns to Coding leadership.
• Provide production coding support as needed based on departmental priorities.

EXPERIENCE

• 5+ years of professional medical coding experience, preferably with orthopedic surgical coding. Must be AAPC/AHIMA certified with maintained credentials

REQUIREMENTS

• Coding Certification from AAPC/AHIMA (CPC, CCS-P, COSC)

KNOWLEDGE

• Knowledge of medical terminology
• Strong experience reviewing operative reports and complex clinical documentation.
• Advanced knowledge of CPT, ICD-10-CM, HCPCS, modifiers, NCCI edits, and payer guidelines.
• Experience with coding audits, reconciliation, workflow analysis, or coding education preferred.

Strong analytical, research, organizational, and communication skills.

• Ability to work independently, manage multiple priorities, and serve as a senior coding subject-matter expert.
• The ability to identify and resolve discrepancies in medical records or claims.
• Accuracy is critical in coding, requiring meticulous attention to detail.
• The ability to communicate effectively with physicians and other healthcare professionals.
• Efficiently inputting and managing coding data.

ABILITIES

• Ability to be a resource for coding guidelines.
• Ability to communicate effectively verbally and in writing.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment. This is a remote position

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching are required.
• Manual dexterity using a calculator and computer keyboard

ESSENTIAL FUNCTIONS

Equal Opportunity Employer
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