| 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. |
| Â 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. |
