Outpatient Surgery, Pre-Authorization Coder

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

👻 Ghost score 18%

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Sage Clinical RCM, LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2024

🏥 Healthcare

☁️ SaaS

🤝 B2B

Healthcare • SaaS • B2B

Sage Clinical RCM is a healthcare revenue cycle management company that combines proprietary technology with clinical and financial expertise to provide end-to-end RCM solutions—from patient access through financial close. The firm offers advisory services, revenue cycle management operations, technology adoption (including clinical documentation improvement and autonomous coding), workforce augmentation (coding, documentation, RCM, physician advisory), and analytics-driven platforms (Sage IQ: Validity and VERO) that use automation and AI to unify coding, documentation, vendor performance, compliance, and financial reporting for healthcare organizations.

📋 Description

• Review clinical documentation and assign CPT, ICD-10-CM, and other applicable codes for outpatient surgical encounters • Code outpatient surgical specialties including orthopedics, fracture treatment, knee procedures, limb-length discrepancy procedures, clubfoot procedures, osteotomies, Ganz procedures, MAGEC/magnetic rod lengthening procedures, casting procedures, cleft lip and palate procedures, dental procedures, hand and upper-extremity procedures, burn laser treatments, skin grafts, lesion excisions, circumcision, and hypospadias procedures • Apply official coding guidelines and client-specific coding requirements • Review returned or queried accounts in the assigned coding queue • Escalate documentation questions or coding concerns through established client processes • Maintain productivity, accuracy, and turnaround expectations • Review clinical and procedural documentation to determine CPT and related procedure codes for pre-authorization workflows • Process approximately 50 pre-authorization cases per day, with fluctuating volume • Support routine and priority/STAT requests • Identify cases requiring additional procedural detail and communicate with designated care managers • Monitor pending cases and follow up when documentation becomes available • Document coding-related notes and follow-up in the client system • Follow client-specific conventions for alternative or multiple procedure codes • Participate in onboarding and knowledge transfer with existing client staff • Learn client-specific workflows, conventions, documentation requirements, and escalation processes • Collaborate with the client's Coding Supervisor and coding team • Support continuity of operations during staffing transitions • Maintain communication about documentation gaps, workflow concerns, and barriers to timely coding • Not responsible for medical-necessity determinations, routine payer-policy or coverage research, obtaining payer authorization, complete authorization lifecycle management, routine queue administration/reassignment, or routine internal coding audits

🎯 Requirements

• Minimum of 3 years of recent outpatient surgery coding experience preferred • Demonstrated experience assigning CPT and ICD-10-CM codes for complex outpatient surgical services • Strong knowledge of CPT guidelines, surgical coding conventions, and outpatient coding requirements • Orthopedic surgical coding experience strongly preferred • Experience with multiple surgical specialties is highly desirable • Previous experience supporting pre-authorization or pre-service coding workflows preferred but not required • Ability to interpret operative notes and other clinical documentation accurately and efficiently • Strong attention to detail and demonstrated coding accuracy • Ability to work independently within established workflows while communicating effectively with coding leadership and clinical teams • Comfortable working in a production-based remote coding environment • One or more nationally recognized coding credentials preferred, such as CCS, CCS-P, CPC, COC, RHIT, or RHIA • Ability to work generally between 7:00 AM and 5:00 PM Eastern Time, based on client operational needs

🏖️ Benefits

• Full-time remote position • Structured onboarding and knowledge transfer • Collaboration with client coding leadership and clinical teams