Mid Coding Specialist II

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 Works under general supervision to perform accurate and compliant coding of moderate-complexity medical and surgical specialties within a highly specialized academic medical center environment. Exercises independent judgment in the review of encounters characterized by moderate to high documentation variability, NCCI bundling edits, payer-specific surgical policies, advanced modifier application, co-surgeon and trainee requirements, validation of incident-to/split-shared services and teaching physician documentation compliance. Evaluates and resolves AI-assisted coding exceptions to ensure coding accuracy, regulatory compliance, audit readiness, and appropriate reimbursement. The role is responsible for coding/abstracting CPTs/ICD-10/modifiers for a large variety of Radiology modalities. This position also abstracts Radiology EMLs for inpatient/outpatient/clinic visits and also performs reconciliation. Cases will include charge review, claim edits, CodeRyte, et al. Work From Home (WFH): This will be a WFH position. Applicant must live within the state of Texas Shift: Monday through Friday, 8-hour flex shift 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 2 years of coding and/or billing experience Preferred Experience Experience coding moderate-complexity specialties and procedures requiring advanced bundling, modifier logic, and payer-specific rule application. Progressive professional billing and or coding responsibility 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 validate moderate-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 moderate-complexity encounters, including multiple interdependent diagnoses, intermediate-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. Evaluates, accepts, modifies, or overrides AI-generated coding outputs from Epic AI Code Assist/Complete, AI EML LOS Assistant, and applicable third-party platforms using advanced clinical and regulatory judgment. Resolves AI exception flags, documentation discrepancies, and code conflicts to ensure audit readiness and clean claim release. Analyzes recurring coding edits, 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 working 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 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. 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. EEO 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. #J-18808-Ljbffr The University of Texas Southwestern Medical Center