Orthopedic Coding & Precertification Manager

Who: A growing orthopedic healthcare organization is seeking an experienced Orthopedic Coding & Precertification Manager to lead coding accuracy, surgical authorizations, compliance, and revenue cycle performance.

What: This leadership position oversees orthopedic coding and precertification operations, ensuring accurate reimbursement, timely authorizations, regulatory compliance, and strong team performance.

When: Immediate opportunity for a qualified healthcare revenue cycle professional ready to take on a key leadership role.

Where: Location to be confirmed.

Why: Join a dynamic orthopedic healthcare organization where your expertise will directly impact operational efficiency, revenue integrity, denial prevention, and patient access to care.

Office Environment: in-office

Salary: $100k-$115k base plus incentive, excellent benefits, generous PTO

Position Overview

We are seeking an experienced Orthopedic Coding & Precertification Manager to oversee coding operations, surgical authorizations, documentation integrity, and revenue cycle performance for a growing orthopedic healthcare organization.

This position plays a critical role in ensuring orthopedic clinical and surgical services are coded accurately, authorizations are secured promptly, and billing processes operate efficiently while maintaining compliance with regulatory and payer requirements.

The ideal candidate combines advanced orthopedic coding expertise with strong leadership capabilities, analytical skills, and a proactive approach to process improvement, denial prevention, and revenue optimization.

Key Responsibilities

Orthopedic Coding & Documentation Integrity

• Oversee accurate coding of orthopedic procedures, including joint replacements, arthroscopy, spine, sports medicine, trauma, fracture care, and injections.

• Ensure compliance with CPT, HCPCS, ICD-10-CM, CMS, NCCI, and payer-specific guidelines.

• Monitor modifier usage, medical necessity, diagnosis specificity, laterality, and global surgery requirements.

• Collaborate with providers to address documentation deficiencies and improve coding accuracy.

Precertification & Authorization Management

• Lead surgical and procedural authorization processes to ensure timely approvals and minimize patient care delays.

• Monitor payer-specific authorization requirements and documentation standards.

• Identify and resolve authorization barriers before scheduled procedures.

• Improve workflows to reduce authorization-related denials and reimbursement delays.

Revenue Integrity & Denial Prevention

• Monitor coding-related charge lag, unbilled charges, and authorization discrepancies.

• Ensure coding and authorization requirements are satisfied before claims are released for billing.

• Partner with Accounts Receivable leadership to analyze coding- and authorization-related denials.

• Implement corrective actions, staff education, and process improvements to prevent recurring issues.

• Identify opportunities to reduce revenue leakage and improve reimbursement performance.

• Provide coding and authorization expertise to support account resolution and appeals.

Team Leadership & Development

• Supervise, coach, and develop coding and precertification professionals.

• Establish and monitor productivity, quality, and performance expectations.

• Manage staffing, workload distribution, training, and accountability.

• Foster a culture of continuous improvement, collaboration, and operational excellence.

Provider Collaboration & Compliance

• Partner with orthopedic surgeons, advanced practice providers, clinical staff, and revenue cycle leadership.

• Educate providers and staff on documentation requirements, coding standards, and payer expectations.

• Conduct internal coding and authorization audits to identify compliance risks.

• Develop corrective action plans and track key operational and financial performance indicators.

• Support departmental initiatives and strategic improvement priorities.

Qualifications

Required Qualifications

• Minimum 5 years of experience in orthopedic coding, revenue cycle management, surgical authorizations, or related healthcare reimbursement operations.

• Minimum 2 years of leadership, management, or supervisory experience.

• Certified Professional Coder (CPC) certification required.

• Strong knowledge of orthopedic surgical coding, precertification, payer authorization requirements, and revenue cycle operations.

• Advanced understanding of CPT, HCPCS, ICD-10-CM, NCCI edits, modifiers, medical necessity, and global surgery rules.

• Familiarity with commercial insurance, workers' compensation, and third-party payer requirements.

• Experience with coding audits, authorization workflows, denial prevention, appeals, and reimbursement processes.

• Strong analytical, organizational, problem-solving, and communication skills.

• Proficiency in Microsoft Excel, practice management systems, EHR platforms, and healthcare reporting tools.

Preferred Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or a related field; equivalent experience considered.

• Experience in an orthopedic physician practice, multi-location orthopedic organization, ambulatory surgery center (ASC), or high-volume surgical environment.

• Background in professional fee billing, surgical coding, payer contract analysis, and revenue cycle analytics.

• Experience with Epic, NextGen, athenahealth, eClinicalWorks, or comparable platforms.

• Experience with Power BI or other business intelligence tools.

• Additional certifications such as COCS, CPMA, COC, CIC, CPC-H or equivalent, CRCR, or CPB.

What Makes This Opportunity Exciting

• **Leadership Impact