About this role
Job Description
Job Title: Revenue Cycle Coder/Biller
Department: Ambulatory Surgery Center (ASC) CBO
Reports To: ASC Revenue Cycle Manager
FLSA Status: Non-Exempt
Approval Date: September 8, 2026
Summary
The Revenue Cycle Coder/Biller supports the coding, billing, reimbursement, and compliance functions of the Ambulatory Surgery Center (ASC) revenue cycle. This role reviews operative reports, assigns accurate diagnosis and procedure codes, captures technical and implant charges, submits clean claims, and supports claim correction and resolution.
As ASC coding transitions in-house, this position will help establish standardized coding processes, workflows, and quality controls while collaborating with physicians, Revenue Cycle, payers, and internal departments. The role will also support the evaluation and implementation of AI-assisted coding, charge capture, and denial management technologies while maintaining professional accountability for coding accuracy and compliance.
Essential Duties and Responsibilities
- Review complex operative reports and support clinical documentation to identify procedures, surgical approaches, diagnoses, secondary diagnoses, implants, and other services requiring coding and billing.
- Assign accurate ICD-10 diagnosis codes and CPT/HCPCS procedure codes based on operative documentation and applicable coding guidelines.
- Apply appropriate modifiers and other claim-specific coding requirements to support accurate reimbursement.
- Help establish in-house ASC coding processes, workflows, and documentation standards as the function transitions from an outside vendor.
- Participate in the evaluation, selection, and implementation of AI-assisted coding, charge capture, and denial management tools, contributing coding expertise to how they are configured and applied.
- Review, validate, and correct system-generated or AI-suggested codes, charges, and claim edits, applying independent professional judgment and retaining accountability for final code assignment.
- Help establish and document the review standards, exception handling, and quality checks that govern automated coding and charge capture as those tools are introduced.
- Identify and communicate error patterns in automated output, providing structured feedback to improve tool accuracy over time.
- Perform accurate and timely charge capture and billing for technical services provided by the Ambulatory Surgery Center.
- Review surgical implant logs and applicable invoices to calculate and enter implant charges accurately.
- Prepare, review, and submit clean claims to commercial payers, Medicare, Medicare Advantage plans, Personal Injury (PI), and other applicable payers.
- Review front-end claim rejections, clearinghouse edits, payer messages, and billing errors and take appropriate action to ensure timely claim submission.
- Correct and rebill claims within the practice management system and submit corrected claims through the clearinghouse as applicable.
- Independently assess claim edits, clearinghouse messages, billing discrepancies, and claim denials to determine appropriate resolution.
- Communicate with physicians and the Director of Coding to obtain clarification when operative documentation is vague, incomplete, or does not adequately support code assignment.
- Document the rationale for any change to a physician-submitted code and ensure changes are reviewed and consistent with established approval and separation-of-duties requirements.
- Review claim and coding documentation for completeness and accuracy prior to submission to reduce billing errors, rejections, and reimbursement delays.
- Monitor coding and billing workflows to ensure claims are processed accurately and within established productivity and turnaround standards.
- Identify and communicate billing trends, coding concerns, clearinghouse issues, claim irregularities, and workflow barriers that may affect clean claim submission or productivity.
- Recommend solutions and corrective actions to the ASC Revenue Cycle Manager and appropriate team members when recurring coding, billing, or claim submission issues are identified.
- Maintain current knowledge of third-party payer billing requirements, ASC reimbursement methodologies, organizational financial policies, coding guidelines, and industry standards.
- Manage complex billing assignments, accounts receivable projects, and payer-requested audits as assigned.
- Utilize analytical and critical-thinking skills to research coding and billing discrepancies and determine appropriate resolution.
- Maintain accurate documentation of coding, billing, claim corrections, and follow-up activities within applicable systems.
- Collaborate with Revenue Cycle, Coding, physicians, clinical teams, and other departments to resolve coding and billing issues and improve workflows.
- Complete annual compliance, regulatory, and organizational training requirements.
- Ensure compliance with HIPAA, CMS guidelines, payer requirements, coding standards, organizational billing policies, and applicable federal and state regulations.
- Identify process improvement opportunities and implement operational efficiencies to improve coding accuracy, clean claim submission, reimbursement, and revenue cycle performance.
- Perform other duties as assigned.
Qualifications
- High school diploma or GED required, Associate or Bachelor's degree in Health Information Management, Healthcare Administration, Business Administration, or a related field preferred.
- Minimum five (5) years of medical billing, coding, and account follow-up experience required.
- ASC, surgical, orthopedic, or facility coding and billing experience preferred.
- Strong knowledge of ICD-10, CPT, HCPCS coding systems, modifiers, and applicable coding guidelines.
- Knowledge of physician and facility billing, charge capture, claim submission, collections, and reimbursement processes.
- Familiarity with CMS-1500 and UB-04 claim requirements and Medicare, Medicare Advantage, managed care, commercial insurance, and Personal Injury billing.
- Experience reviewing operative reports and translating surgical documentation into accurate diagnosis and procedure codes.
- Ability to research and resolve front-end claim rejections, clearinghouse edits, billing errors, denials, and corrected claims.
- Intermediate to advanced Microsoft Excel skills preferred.
- Experience with AI-assisted or automated coding, charge capture, or denial management tools preferred; genuine interest in helping implement them required.
- Experience transitioning coding functions in house or building coding processes from the ground up preferred.
- Comfort building process in a newly defined role, and the judgment to know when to accept a system recommendation and when to override it.
- Proficiency with Microsoft Word, Excel, PowerPoint, practice management systems, clearinghouses, and healthcare billing technology.
- Ability to type a minimum of 55 words per minute and effectively utilize calculators and standard office equipment.
- Strong analytical, critical-thinking, organizational, communication, customer service, and problem-solving skills.
- Ability to work independently with minimal supervision while managing multiple complex assignments and maintaining accuracy and productivity.
Supervisory Responsibilities
This position has no direct supervisory responsibilities.
Certificates, Licenses, Registrations
- Certified Professional Coder (CPC) preferred.
- Certified Coding Specialist (CCS) preferred.
Physical Demands & Work Environment
This position is performed in a professional office and healthcare environment requiring prolonged periods of sitting, standing, walking, and computer use. Occasional travel between clinic locations may be required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.
Peachtree Orthopedics is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
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