Medical Billing & Coding - Orthopedics

We are a growing orthopedic practice looking for a skilled Medical Assistant or Orthopedic Technologist with a passion for people! You will play a pivotal role in ensuring patients receive great care and have a wonderful experience from the moment they walk in until the moment they leave. We believe in going above and beyond, and feel that there is no nobler pursuit than that of caring for others and helping to improve their quality of life. We hope you'll join us on our mission!

GENERAL SUMMARY OF DUTIES

The Medical Billing Coder is responsible for accurate coding and billing of orthopedic services — including surgical procedures, office visits, ancillary services, and DME — as well as denial management and internal billing audits to ensure compliance, documentation accuracy, and timely revenue recovery. This role requires deep expertise in orthopedic procedure coding, demonstrated proficiency with the Athena EMR and Practice Management system, and a track record of performing internal audits. The position carries leadership potential, with the expectation that the selected candidate may assume supervisory or managerial responsibilities as operational needs evolve.

ESSENTIAL FUNCTIONS

Surgical Procedure & Office Visit Coding Accurately assigns ICD-10-CM, CPT, and HCPCS Level II codes for a full range of orthopedic surgical procedures including joint replacements, arthroscopy, fracture care, spine surgery, and soft tissue procedures. Codes evaluation and management (E/M) services including new patient visits, established patient visits, consultations, and post-operative follow-up encounters in compliance with current CMS E/M guidelines. Reviews operative reports, procedure notes, and clinical documentation to ensure code selection accurately reflects the complexity and medical necessity of services rendered. Applies appropriate modifiers for surgical procedures, bilateral services, assistant surgeons, and multiple procedure reductions in accordance with payer guidelines. Submits clean claims to Medicare, Medicaid, and commercial payers within required timelines and monitors accounts for timely reimbursement. Monitors and resolves claim denials and rejections; initiates and tracks appeals through resolution. Manages charge entry and charge review workflows within the Athena platform. Ancillary Services Coding — Rehab, MRI & Imaging, DME Codes physical therapy, occupational therapy, and rehabilitation services including therapeutic exercises, manual therapy, neuromuscular re-education, and functional capacity evaluations in compliance with applicable billing rules and payer guidelines. Assigns accurate CPT and HCPCS codes for diagnostic imaging services including X-ray, MRI, and other musculoskeletal imaging studies performed within the practice, including global and technical/professional component billing where applicable. Codes and processes durable medical equipment (DME) claims including braces, orthotics, supports, and assistive devices; ensures accurate HCPCS Level II code assignment, ABN completion, and payer-specific documentation requirements are met. Verifies medical necessity documentation for ancillary services to support clean claim submission and reduce denials across rehab, imaging, and DME service lines. Monitors ancillary charge capture workflows and collaborates with clinical and DME staff to resolve documentation gaps or coding discrepancies. Athena EMR System Management Serves as a subject matter expert for Athena billing and practice management modules. Utilizes Athena reporting tools to track key revenue cycle metrics such as days in A/R, denial rates, and clean claim rates across all service lines. Collaborates with IT and implementation teams on Athena workflow optimization, updates, and staff training. Maintains accurate patient account information and ensures coding documentation aligns with Athena system requirements. Auditing & Compliance Conducts routine and targeted internal audits of billing records across surgical, E/M, rehab, imaging, and DME service lines to identify coding errors, documentation gaps, and potential compliance risks. Prepares written audit findings and presents results to management with actionable recommendations. Ensures ongoing compliance with CMS guidelines, OIG work plan priorities, payer-specific policies, and HIPAA regulations. Maintains up-to-date knowledge of annual ICD-10 and CPT code changes, payer bulletins, and orthopedic-specific LCD/NCD updates. Supports external audit preparation and responds to payer audit requests with organized, timely documentation. Leadership & Team Support Mentors and provides day-to-day guidance to team members. Ability to oversee processes and people when needed, including overseeing workflow distribution. Conducts training sessions on orthopedic coding updates, payer policy changes, and Athena system best practices. Partners with orthopedic providers and clinical staff to resolve documentation deficiencies and improve coding accuracy at the point of care. Contributes to department process improvement initiatives and assists leadership in developing billing policies and procedures.

EDUCATION

Associate's or Bachelor's Degree in Health Information Management, Business, or related field preferred; or equivalent experience.

Active coding credential required:

CPC (AAPC) or

CCS/CCS-P

(AHIMA); COC or OCS (Orthopaedic Surgery) specialty credential strongly preferred.

EXPERIENCE

Minimum 3-5 years of medical billing and coding experience with a significant focus on orthopedics. Experience coding across multiple service lines including surgical procedures, E/M visits, rehabilitation, diagnostic imaging, and DME required. Proven hands-on experience with the Athena EMR and Practice Management platform required. Demonstrated experience performing internal billing or coding audits required. Prior supervisory, lead, or team coordinator experience in a billing or coding department preferred.

KNOWLEDGE

Orthopedic surgical procedure coding, E/M visit coding, and musculoskeletal documentation requirements. Ancillary service coding for rehabilitation therapy, diagnostic imaging (X-ray/MRI), and durable medical equipment. ICD-10-CM, CPT, and HCPCS Level II coding guidelines for orthopedic and musculoskeletal services. Medicare/Medicaid billing regulations, payer-specific guidelines, and orthopedic-related LCDs and NCDs. DME documentation requirements including ABNs, certificates of medical necessity, and HCPCS coding. Athena EMR billing and practice management modules. HIPAA regulations and healthcare compliance standards. Denial management, appeals processes, and A/R follow-up workflows.

SKILLS:

Strong working knowledge of orthopedic CPT, ICD-10-CM, and HCPCS coding across surgical, E/M, rehab, imaging, and DME service lines. Proficiency with Athena EMR and practice management reporting tools. Ability to conduct, document, and present internal billing audits. Effective written and verbal communication with providers, clinical staff, and payers. High degree of accuracy and attention to detail with strong organizational and time management skills. Proficiency with Microsoft Office Suite (Word, Excel, Outlook).

ABILITIES

Ability to interpret and apply complex coding guidelines and payer-specific billing rules across multiple service lines. Ability to identify billing and documentation deficiencies and implement corrective solutions. Ability to manage multiple priorities and meet deadlines in a high-volume billing environment. Ability to mentor, and support billing staff in a team-oriented setting. Ability to remain professional and composed under pressure, including during audits or payer disputes. Ability to adapt to annual code updates, payer policy changes, and evolving compliance requirements.

ENVIRONMENTAL WORKING CONDITIONS

Position is on-site and not a remote position. Frequent interaction with providers, clinical staff, billing team members, and payer representatives. May occasionally be required to attend on-site meetings, provider training sessions, or audit reviews.

PHYSICAL/MENTAL DEMANDS

Prolonged periods of sitting and computer use. Occasional stress related to audit timelines, denial volumes, or payer disputes. Must be able to remain seated for extended periods and lift up to 20 lbs occasionally.

Job Type:

Full-time Job Type:

Full-time Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance Application Question(s): What electronic medical records system are you familiar with?

Experience:

Medical coding: 3 years (Preferred) Medical billing: 3 years (Preferred)

Work Location:

In person