Bariatric Coder (PRN)

Description

Performs day-to-day professional-fee coding for bariatric surgery partner organizations on a PRN (as-needed) basis. Translates bariatric clinic, operative, and follow-up documentation into accurate, compliant claims data to support clean claims and reduce downstream denials. Provides flexible coding capacity during volume surges, coverage gaps, and backlog reduction, and escalates documentation and coding issues to project leadership as needed.

Duties and Responsibilities

Coding Operations

• Reviews bariatric surgery clinic, operative, and follow-up documentation and assigns accurate CPT, HCPCS, ICD-10-CM, and applicable modifier codes.
• Codes common bariatric procedures, including sleeve gastrectomy, Roux-en-Y and other gastric bypass, duodenal switch and SADI-S, and adjustable gastric band placement, removal, replacement, and adjustment.
• Codes revisional and conversion procedures (such as sleeve-to-bypass or band-to-sleeve) and reoperations, and identifies when unlisted codes are appropriate and what documentation supports them.
• Determines when related services are separately reportable or bundled, including hiatal hernia repair, intraoperative endoscopy, and cholecystectomy.
• Assigns evaluation and management (E/M) levels for pre-operative consultations, post-operative visits, and surgical and nutrition follow-up based on current AMA guidelines for medical decision making or total time.
• Assigns diagnosis codes that support medical necessity, including obesity class, BMI Z-codes, obesity-related comorbidities (such as type 2 diabetes, hypertension, sleep apnea, and GERD), bariatric surgery status, and post-operative complications.
• Applies modifiers appropriately, including -22, -25, -51, -58, -59/X modifiers, -62, -78, -79, -80/-82, and laterality modifiers, with documentation to support them.
• Applies global surgical package rules, distinguishing routine post-operative care from unrelated or complication-related services.
• Codes related services as applicable, including medical nutrition therapy, pre-operative psychological evaluations, and supervised weight management visits.
• Meets established productivity and accuracy benchmarks, to be defined with the client.
• Queries providers when documentation is unclear, incomplete, or conflicting (for example, missing BMI, comorbidities, or procedure detail), and tracks query responses to resolution.

Compliance and Knowledge

• Applies NCCI edits, CMS and AMA guidelines, and payer-specific bariatric coverage policies to ensure compliant coding.
• Verifies that documentation supports payer requirements for bariatric surgery, such as BMI thresholds, comorbidity documentation, supervised diet history, psychological clearance, and prior authorization.
• Stays current on annual code set updates (ICD-10-CM in October; CPT and HCPCS in January).
• Maintains the confidentiality and security of PHI in accordance with HIPAA and client requirements.
• Knows, understands, incorporates, and demonstrates the Healthrise Core Values.

PRN Engagement

• Accepts and completes assignments within agreed turnaround times, communicating availability and capacity clearly to project leadership.
• Ramps quickly on client-specific coding policies, EHR workflows, and billing models for each assignment.

Quality and Process Improvement

• Participates in quality audits, feedback sessions, and ongoing education, and incorporates feedback into daily work.
• Identifies and escalates trends in denials (such as medical necessity, missing pre-authorization, modifier errors, and global period violations), documentation gaps, or coding issues to project leadership.
• Documents all actions and query outcomes in the client’s coding and billing systems.
• Performs other duties as assigned.

Requirements

Required

• Active professional coding credential in good standing, such as CPC, CCS, or CCS-P.
• Minimum of two (2) years of recent, hands-on bariatric, general surgery, or surgical professional-fee coding experience.
• Experience with major EHR and encoder platforms (Epic, athenahealth, eClinicalWorks, Cerner/Oracle Health, 3M, Optum, or equivalent).
• Working knowledge of CPT, HCPCS Level II, ICD-10-CM, E/M guidelines, modifiers, NCCI edits, and bariatric procedure coding, including sleeve, bypass, band, and revisional procedures.
• Strong understanding of global surgical package rules and surgical modifiers.
• Located in and authorized to work in the United States.
• Reliable high-speed internet and a secure workspace that meets HIPAA requirements.
• Excellent written and verbal communication and organizational skills.
• Attention to detail, accuracy, and time management.

Preferred

• Certified General Surgery Coder (CGSC) or other surgical specialty credential.
• Experience coding bariatric revisions, conversions, and complication management.
• Familiarity with Medicare NCD 100.1 and commercial payer bariatric coverage criteria, including prior authorization documentation and denial management.
• Prior PRN, contract, or project-based coding experience.
• Demonstrated accuracy rate of 95% or higher.
• Completion of regulatory/mandatory certifications.