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 Coding

• Code high-complexity spine procedures (e.g., fusions, decompressions, instrumentation, revisions)


• Verifying all documentation is complete and compliant


• Assigns 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 necessity


• Validate:


• Levels, laterality, approach (anterior/posterior)


• Instrumentation and graft usage


• Identify missed billable components (e.g., additional levels, hardware, biologics)


• Query provider for any necessary clarification related to unclear, unspecified or missing/incomplete documentation


• Apply payer-specific coding rules and edits

Denial Prevention & Root Cause Ownership

• Researches, 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 identification


• Partner with RCM and vendor teams to implement corrective actions


• Develop coding edits and pre-bill review processes for high-risk procedures

Pre-Bill Quality Review

• Perform targeted pre-bill audits for:


• High-dollar spine surgeries


• Multi-level and complex cases


• Ensure documentation supports:


• Medical necessity


• Procedure specificity


• Escalate documentation gaps prior to claim submission

Provider Documentation Improvement

• Partner with surgeons to improve documentation quality


• Provide targeted, case-based feedback:


• Missing elements impacting coding accuracy


• Opportunities to fully capture procedure complexity


• Support education on:


• Modifier usage


• Documentation specificity (levels, implants, approach)

Vendor Oversight & Coding Quality Control

• Audit external coding vendor performance (if applicable)


• Identify discrepancies between internal and vendor coding


• Provide feedback and enforce coding standards


• Support development of SOPs and coding guidelines


• Serves as primary resource and Spire Point of Contact (SPOC) between provider and vendor

Appeals

• Support appeals for coding-related denials


• Provide clinical/coding rationale and documentation validation


• Partner with AR teams on high-value accounts