Surgical Coder/Auditor

Job Details

Texas Institute for Surgery LL SURG - Dallas, TX

Full Time

Description

Description

Review operative and clinical documentation to assign appropriate CPT, ICD-10-CM, ICD-10-PCS, and modifiers for orthopedic surgeries.

Assign and validate MS-DRGs and APR-DRGs for inpatient encounters based on documentation and coding guidelines.

Audit coding and billing work performed by third-party vendors to ensure accuracy, compliance, and adherence to hospital policies.

Analyze and resolve insurance denials related to coding, documentation, and DRG assignment.

Prepare and submit appeals with supporting documentation for denied claims, including DRG downgrades.

Collaborate with physicians, clinical staff, and external vendors to clarify documentation and resolve coding discrepancies.

Maintain current knowledge of payer policies, coding guidelines, DRG grouping logic, and orthopedic surgical procedures.

Track and report coding accuracy, denial trends, and audit findings to leadership.

Assist in training and onboarding of new coding staff or vendors as needed.

Ensure compliance with HIPAA, CMS, and other regulatory requirements.

Other duties as assigned.

The Surgical Coder/Auditor is responsible for accurate coding of inpatient and outpatient orthopedic surgical procedures using CPT, ICD-10-CM, ICD-10-PCS, and HCPCS codes. This hospital-based role includes DRG assignment and validation, auditing of coding performed by external billing vendors, and managing insurance denials. The coder ensures compliance with regulatory requirements and supports optimal reimbursement through accurate documentation and coding practices.

Qualifications

Education & Training: Licenses / Certifications:

High school diploma or equivalent required, Associates or Bachelor's Degree preferred. Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), or Certified Professional Coder (CPC) required.

Orthopedic coding certification preferred (e.g., COSC).

Experience: Key Skills:

Minimum 3–5 years of surgical coding experience, with at least 2 years in orthopedics. Strong knowledge of CPT, ICD-10-CM, ICD-10-PCS, HCPCS, and DRG grouping systems.

Experience with DRG assignment and validation in a hospital setting Familiarity with orthopedic terminology and procedures

Experience auditing coding work and handling insurance denials and appeals. Proficiency in EHR and billing systems ( Epic, Cerner, or similar), CPSI preferred.

Excellent written and verbal communication skills

Detail-oriented with strong organizational and analytical abilities