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, manages team performance, prevents denials, and ensures accurate and timely reimbursement.

When: The organization is seeking a qualified candidate to join its leadership team as soon as possible.

Where: Atlanta, Georgia.

Why: This is an opportunity to lead a critical revenue cycle function, improve operational efficiencies, develop a high-performing team, and make a measurable impact on financial performance and patient access.

Office Environment: A collaborative, fast-paced orthopedic healthcare environment working closely with surgeons, clinical teams, surgery schedulers, and revenue cycle leadership.

Salary: Competitive compensation based on experience and qualifications.

Position Overview

We are seeking an experienced Orthopedic Coding & Precertification Manager to oversee coding accuracy, surgical authorization processes, regulatory compliance, and operational performance for a growing orthopedic healthcare organization in Atlanta.

The ideal candidate combines extensive orthopedic coding expertise with strong leadership skills and a comprehensive understanding of healthcare reimbursement and revenue cycle operations.

This individual will lead coding and precertification teams, optimize workflows, minimize revenue leakage, and collaborate with physicians and operational leaders to improve documentation quality, authorization success, and reimbursement outcomes.

This is an excellent opportunity for a results-driven healthcare professional who enjoys developing teams, solving complex revenue cycle challenges, and driving continuous improvement.

Key Responsibilities

Orthopedic Coding & Documentation Integrity

• Oversee accurate coding of orthopedic clinical and surgical services, 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 coding requirements.

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

• Partner with physicians and clinical teams to improve documentation accuracy and completeness.

Precertification & Authorization Management

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

• Monitor payer authorization requirements and documentation standards.

• Identify and resolve authorization barriers before services are performed.

• Develop process improvements that increase efficiency and reduce authorization-related denials.

Revenue Cycle & Denial Prevention

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

• Ensure coding and authorization documentation is complete before claims are submitted.

• Collaborate with accounts receivable leadership to identify and address denial trends.

• Implement corrective actions to reduce recurring denials and prevent revenue leakage.

• Support resolution of complex coding, documentation, and reimbursement issues.

Team Leadership & Operational Performance

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

• Establish productivity, accuracy, quality, and accountability standards.

• Monitor team performance through reporting, audits, and operational metrics.

• Manage staffing, workflow distribution, training, and employee development.

• Foster a collaborative, results-oriented team culture.

Compliance, Reporting & Process Improvement

• Conduct coding and authorization audits to identify compliance risks and improvement opportunities.

• Ensure adherence to federal regulations, payer policies, and industry coding standards.

• Track operational and financial performance indicators.

• Collaborate with revenue cycle leadership to implement sustainable process improvements.

• Provide education to physicians and staff regarding coding requirements, documentation, and payer expectations.

Qualifications

Required Qualifications

• Minimum of 5 years of experience in orthopedic coding, revenue cycle management, authorization, or healthcare reimbursement.

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

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

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

• Experience with coding audits, denials, appeals, and reimbursement-related processes.

• Knowledge of commercial insurance, workers' compensation, and third-party payer requirements.

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

• Proficiency in Microsoft Excel, electronic health records, practice management systems, and healthcare reporting tools.

• CPC (Certified Professional Coder) certification required.

Preferred Qualifications

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

• Experience working within an orthopedic physician practice, multi-location healthcare organization, ambulatory surgery center, or high-volume surgical environment.

• Experience with professional fee billing, surgical coding, payer contract analysis, and revenue cycle analytics.

• Familiarity with Epic, NextGen, athenahealth, eClinicalWorks, or similar EHR/practice management platforms.

• Experience using Power BI or comparable business intelligence tools.

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

What Makes This Opportunity Attractive

• Leadership opportunity within a specialized orthopedic healthcare environment.

• Ability to directly influence revenue cycle performance and operational efficiency.

• Opportunity to build and mentor a high-performing coding and authorization team.

• Close collaboration with physicians, clinical leaders, and revenue cycle management.

• Meaningful involvement in process improvement, compliance, and organizational growth.