Surgical Coder - Spine Specialty

Who we are:Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most - patient care. Headquartered in Stamford, Connecticut, the Spire network spans the Northeast with more than 165 physicians, 1,800 employees, 285 other clinical providers and 40 locations in New York, Connecticut, Rhode Island and Massachusetts.What you'll do:The Surgical Coder for Spine is responsible for accurate and compliant coding of complex orthopedic spine procedures across all care settings. This role directly impacts revenue integrity by ensuring optimal CPT/ICD-10 coding, minimizing denials, and supporting provider's documentation improvement.Responsibilities/Duties:Complex Spine CodingCode high-complexity spine procedures (e.g., fusions, decompressions, instrumentation, revisions)Verifying all documentation is complete and compliantAssigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.Follows coding conventions and ensure accurate assignment of:CPT (including add-on codes, modifiers, bundling rules)ICD-10 diagnoses supporting medical necessityValidate:Levels, laterality, approach (anterior/posterior)Instrumentation and graft usageIdentify missed billable components (e.g., additional levels, hardware, biologics)Query provider for any necessary clarification related to unclear, unspecified or missing/incomplete documentationApply payer-specific coding rules and editsDenial Prevention & Root Cause OwnershipResearches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future coding errors:Review coding-related denials (medical necessity, bundling, documentation)Perform root cause analysis and trend identificationPartner with RCM and vendor teams to implement corrective actionsDevelop coding edits and pre-bill review processes for high-risk proceduresPre-Bill Quality ReviewPerform targeted pre-bill audits for:High-dollar spine surgeriesMulti-level and complex casesEnsure documentation supports:Medical necessityProcedure specificityEscalate documentation gaps prior to claim submissionProvider Documentation ImprovementPartner with surgeons to improve documentation qualityProvide targeted, case-based feedback:Missing elements impacting coding accuracyOpportunities to fully capture procedure complexitySupport education on:Modifier usageDocumentation specificity (levels, implants, approach)Vendor Oversight & Coding Quality ControlAudit external coding vendor performance (if applicable)Identify discrepancies between internal and vendor codingProvide feedback and enforce coding standardsSupport development of SOPs and coding guidelinesServes as primary resource and Spire Point of Contact (SPOC) between provider and vendorAppealsSupport appeals for coding-related denialsProvide clinical/coding rationale and documentation validationPartner with AR teams on high-value accounts