Mid Coding Specialist II

Job Summary The Mid Coding Specialist II 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. This role supports cases involving Physical Medicine & Rehabilitation/Spine, General Internal Medicine, Hematology/Oncology, and Rheumatology. The specialist exercises independent judgment in reviewing encounters with moderate to high documentation variability, handles 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. Responsibilities Support multiple specialties in a hybrid or float capacity as needed. Meet productivity and quality standards set by coding leadership. Review and validate moderate‑complex physician encounter documentation within Epic to ensure accurate and compliant ICD‑10‑CM, CPT, and HCPCS code assignment prior to claim submission. Identify and mitigate compliance risks associated with moderate‑complexity encounters, including multiple interdependent diagnoses, intermediate‑risk procedures, split/shared and incident‑to services, and teaching physician documentation. Review and resolve coding‑related edits, including NCCI bundling conflicts, modifier application, MUE limits, payer‑specific requirements, and global surgical package considerations. Evalue, 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. Resolve AI exception flags, documentation discrepancies, and code conflicts to ensure audit readiness and clean claim release. Analyze recurring coding edits, AI variances, and denial trends, perform root‑cause review and communicate findings to leadership when systemic issues are identified. Collaborate with providers to clarify documentation and ensure accurate code capture that supports medical necessity and reimbursement. Partner with billing and denial management teams to resolve coding‑related rejections and underpayments. Maintain working knowledge of ICD‑10‑CM, CPT, HCPCS, payer policies, LCD/NCD guidelines, and regulatory updates. Participate in internal audits, quality assurance initiatives, Epic upgrades, and AI workflow optimization projects. Adhere to all organizational policies, compliance standards, data security requirements, and performance expectations. Perform other duties as assigned. Qualifications High school diploma or GED equivalent. Minimum 2 years of coding and/or billing experience. Experience coding moderate‑complexity specialties and procedures with advanced bundling, modifier logic, and payer‑specific rule application. Professional experience in academic medical centers, multi‑specialty physician groups, or complex ambulatory environments. Experience resolving charge review edits and backend 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, CCS‑P, CMC, RHIA, RHIT, CCS, CPMA, or other relevant qualifications. Benefits 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. Security & EEO Statement Security: This position is security‑sensitive and subject to Texas Education Code §51.215, authorizing 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 based on race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status. Location & Schedule Location: 5323 Harry Hines Blvd, Dallas, TX. Schedule: Full‑time, Day Job. Shift: 8‑hour flex shift, Monday through Friday. This role is available to candidates residing in Texas; work‑from‑home is allowed if the candidate lives in TX (not required to reside in D/FW area). #J-18808-Ljbffr UT Southwestern Medical Center