Senior Medical Coding Ops Lead (Remote)

The CORE Institute; Phoenix (AZ); Remote; USD 85,000 - 115,000; Full time

Job summary

The CORE Institute is seeking a senior medical coder with extensive orthopedic coding experience. You will act as a senior resource for complex procedural and payer-related coding questions, while ensuring accuracy through CPT/ICD-10-CM guidelines and payer policies.

Responsibilities include monitoring backlogs, reconciling workflows, and supporting audits and education to improve coding accuracy and compliance. This remote role requires strong analytical and communication skills.

Qualifications

• 5+ years of professional medical coding experience, preferably orthopedic surgical coding.
• AAPC or AHIMA certification maintained.
• Proficient in CPT, ICD-10-CM, HCPCS and NCCI guidelines.
• Experience with coding audits, workflow reconciliation, and education.

Responsibilities

• Monitor backlogs, turnaround times, missing documentation, and workflow exceptions.
• Reconcile coding work queues, surgery schedules, and charge capture systems.
• Serve as a senior coding resource for complex procedural and payer-related questions.
• Research and apply coding policies and regulatory guidance.
• Support audit trend analysis and contribute to corrective education.

Skills

Orthopedic coding

CPT/ICD-10-CM

Payer policy knowledge

Audits & reconciliation

Clinical documentation review

Education

AAPC/AHIMA certification

Tools

EFS/charge capture systems

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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