Coding Specialist III

Coding Specialist III

WHY UT SOUTHWESTERN? 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!

JOB SUMMARY UT Southwestern Medical Center has a new opportunity within the Revenue Cycle Department for the role of Coding Specialist III. 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.

The duties for this position will include but is not limited to the following:

• Codes and audits patient encounters to ensure accurate documentation
• Codes for the OBGYN department
• Understanding governmental and payer policies when it comes to coding guidelines

About the culture - The culture is the shared commitment to accuracy, compliance, ethical practices, and collaboration that ensures high quality documentation and protects organizational integrity. The successful applicant will work under general supervision to perform complex coding activities in a manner that meets productivity and quality standards as established by coding leadership. Work from home (WFH): The successful applicant will work from home but must live within the State of Texas. Candidates who live in the DFW are preferred. Shift: 8-hour days, Monday through Friday, flex-shift (Additional details to be discussed during the interview).

BENEFITS UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. 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 Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION Required Education High School Diploma or GED Equivalent Experience 4 years of coding and/or billing experience Preferred Experience Experience coding high-complexity specialties and procedures requiring advanced bundling, modifier logic, and payer-specific rule application. Progressive professional billing and coding experience and advanced technical proficiency. Experience in academic medical centers, multi-specialty physician groups, or complex ambulatory environments. Experience resolving charge review edits and back-end coding denials, including root-cause analysis and collaboration with providers and operational leaders. Experience supporting revenue integrity initiatives, compliance auditing, clinical documentation improvement (CDI), or operational performance improvement efforts. Experience working independently in a fast-paced, metric-driven, AI-enabled environment managing multiple work queues and shifting specialty assignments. 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

JOB DUTIES 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 additional duties as assigned. Performs other duties as assigned.

Knowledge, Skills and Abilities Work requires advanced knowledge of ICD-10-CM, CPT, and HCPCS coding systems, including global surgical package rules, complex modifier application and sequencing, and advanced procedure coding guidelines (depending on specialty assignment). Work requires ability to interpret complex clinical documentation and apply accurate coding in accordance with coding guidelines and payer requirements. Work requires comprehensive understanding of medical terminology, anatomy, physiology, and specialty-specific documentation requirements. Work requires comprehensive understanding of federal and state regulations, payer policies, compliance standards, and reimbursement methodologies, including NCCI edits and modifier application, as well as teaching physician documentation guidelines and academic billing requirements. Work may require advanced knowledge of AI-assisted coding technologies and their application in coding workflows (e.g., Epic AI tools, and third-party AI platforms). Work requires advanced proficiency in Epic Professional Billing or other electronic health record (EHR) and billing systems. Work requires advanced analytical, critical-thinking, and problem-solving skills, along with effective communication skills to support coding accuracy, resolve issues, educate providers, and collaborate with cross-functional teams. Work requires the ability to work independently and manage multiple priorities in a fast-paced, technology-enabled environment, with strong organizational skills to meet productivity, quality, and performance metrics while maintaining a commitment to accuracy, compliance, customer service, and continuous improvement.

PHYSICAL DEMANDS/WORKING CONDITIONS Physical Demands Repetitive Motions Sitting Working Conditions Indoors Office Setting

SECURITY AND EEO STATEMENT Security This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information. To the extent this position requires the holder to research, work on, or have access to critical infrastructure as defined in Section 113.001(2) of the Texas Business and Commerce Code, the ability to maintain the security or integrity of the critical infrastructure is a minimum qualification to be hired and to continue to be employed in the position. EEO Statement UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.