Coding Specialist III

About the role

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.

Responsibilities

• Works under general supervision to perform complex coding activities in a manner that meets productivity and quality standards as established 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.
• Supports 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 E&M 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, 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.
• Functions 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.

Requirements

• 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.

Qualifications

• 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 TECHNOLOGIST or (CCS) CERT CODING SPECIALIST or (CPMA) Cert Prof Medical Auditor

Skills and Abilities

• 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).
• Comprehensive understanding of medical terminology, anatomy, physiology, and specialty-specific documentation requirements.
• 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.
• Advanced knowledge of AI-assisted coding technologies and their application in coding workflows (e.g., Epic AI tools, and third-party AI platforms).
• Advanced proficiency in Epic Professional Billing or other electronic health record (EHR) and billing systems.
• 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.
• 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.

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
• Retail Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF)

Pay

Commensurate with experience

Schedule

8-hour days, Monday through Friday, flex-shift (Additional details to be discussed during the interview).