Mid Coding Specialist III

Mid Coding Specialist III

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!

Works under general supervision to perform advanced, accurate, and compliant coding of high-complexity surgical, procedural, and interventional specialties within a highly specialized academic medical center environment. Exercises independent judgment in the review of encounters characterized by high documentation variability, evolving intraoperative findings, multi-procedure operative cases, complex bundling and add-on logic, advanced payer nuance and regulatory interpretation, device-intensive procedures, validation of incident-to/split-shared services, and teaching physician documentation compliance. Supports audit and denial escalation review and evaluates and resolves high-risk AI-assisted coding exceptions to ensure regulatory compliance, audit readiness, and optimal reimbursement.

Our benefits are designed to support your overall wellbeing, and include: PPO medical plan, available day one at no cost for full-time employee-only coverage 100% coverage for preventive healthcare-no copay Paid Time Off, available day one Retirement Programs through the Teacher Retirement System of Texas (TRS) Paid Parental Leave Benefit Wellness programs Tuition Reimbursement Public Service Loan Forgiveness (PSLF) Qualified Employer

Required Education: High School Diploma or GED Equivalent Experience: 4 years of coding and/or billing experience Licenses and Certifications: (CPC) CERT PROFESSIONAL CODER or (CCS-P) CERT CODING SPCLST PHY BA or (CMC) CERT MEDICAL CODER or (RHIA) REGD HEALTH INFO ADMINIST or (RHIT) REGD HEALTH INFO TECHNOLO or (CCS) CERT CODING SPECIALIST or (CPMA) Cert Prof Medical Auditor

Meets productivity and quality standards set by coding leadership. Reviews and validates high-complex physician encounter documentation within Epic to ensure accurate and compliant documentation, ICD-10-CM, CPT, and HCPCS code assignment prior to claim submission. Identifies and mitigates compliance risks associated with high-complexity encounters, including multiple interdependent diagnoses, high-risk procedures, split/shared and incident to services, and teaching physician documentation. May support multiple specialties in a hybrid role as needed. Reviews and resolves coding-related edits, including NCCI bundling conflicts, modifier application, MUE limits, payer-specific requirements, and global surgical package considerations. May evaluate, accept, modify, or override AI-generated coding outputs from Epic AI Code Assist/Complete, AI E&M LOS Assistant, and applicable third-party platforms using advanced clinical and regulatory judgment. May resolve AI exception flags, documentation discrepancies, and code conflicts to ensure audit readiness and clean claim release. Analyzes recurring coding edits, may analyze AI variances, and denial trends; performs root cause review and communicates findings to leadership when systemic issues are identified. Collaborates with providers to clarify documentation and ensure accurate code capture that supports medical necessity and reimbursement. Supports denial prevention efforts by partnering with billing and denial management teams to resolve coding-related rejections and underpayments. Maintains advanced knowledge of ICD-10-CM, CPT, HCPCS, payer policies, LCD/NCD guidelines, and regulatory updates. Participates in internal audits, quality assurance initiatives, Epic upgrades, and may participate in AI workflow optimization projects. May function in a float capacity, providing coding support to maintain operational coverage and productivity standards. Adheres to all organizational policies, compliance standards, data security requirements, and performance expectations. Performs other duties as assigned.