Sr. Medical Coding Educator

About the role

The US Oncology Network is seeking a Senior Medical Coding Educator to join Texas Oncology’s Revenue Cycle Department at 3001 E. President George Bush Hwy Suite 100, Richardson, Texas. This full-time, senior-level position operates Monday through Friday, 8:00 a.m. – 5:00 p.m. Texas Oncology is the nation’s largest community oncology provider, with approximately 530 providers across 280+ sites, delivering high-quality, evidence-based cancer care close to home. As part of The US Oncology Network—supported by McKesson Corporation—the role advances the science, technology, and quality of community-based cancer care.

Responsibilities

• Performs complex reviews and investigations involving coding, documentation, billing, reimbursement, systems, workflows, operational processes, and related quality concerns.
• Receives and evaluates review requests originating within Coding Operations or from organizational stakeholders requiring coding and operational expertise.
• Establishes the appropriate scope and review methodology based on the reported concern, potential risk, available information, and affected services or processes.
• Reviews medical records, provider documentation, coding, charges, claims, billing activity, system configuration, operational workflows, policies, procedures, and supporting data to determine the facts and circumstances related to each concern.
• Evaluates concerns from all applicable perspectives and does not limit the investigation to the initially reported issue or assumed cause.
• Determines whether the identified issue is related to coding, documentation, billing, reimbursement, payer requirements, system configuration, workflow, process design, training, staff activity, provider activity, or a combination of factors.
• Conducts focused audits, medical record reviews, claim reviews, data validation, coding validation, and other investigative activities necessary to confirm the concern and determine its scope.
• Researches applicable CPT, HCPCS, ICD-10-CM, CMS, Medicare Administrative Contractor, National Correct Coding Initiative, payer, regulatory, and organizational guidance.
• Distinguishes between the reported concern, validated finding, contributing factors, and root cause before communicating conclusions.
• Identifies the population, time frame, specialties, providers, locations, claims, charges, or workflows potentially affected by the issue.
• Assesses the potential coding, documentation, billing, reimbursement, operational, financial, and compliance impact of validated findings.
• Documents the concern received, investigative steps completed, evidence reviewed, findings, root cause, scope, impact, and recommended actions.
• Ensures conclusions and recommendations are supported by medical record documentation, data, authoritative guidance, system evidence, workflow validation, or other appropriate supporting information.
• Prepares clear and concise reports of findings and recommendations for Coding leadership and other appropriate stakeholders.
• Identifies patterns, trends, control weaknesses, system issues, documentation deficiencies, coding concerns, billing risks, workflow barriers, and recurring operational problems.
• Determines when additional departments or subject-matter experts must be involved and coordinates their participation in the review.
• Collaborates with Coding Operations, Audit Operations, Education, Operations, Revenue Cycle, Information Technology, Compliance, reimbursement, clinical leadership, providers, and other stakeholders to validate findings and determine appropriate next steps.
• Facilitates communication among involved stakeholders to clarify responsibilities, address dependencies, and prevent gaps in issue resolution.
• Develops or recommends corrective actions based on the validated root cause, identified risk, and affected process.
• Documents responsible owners, required actions, expected deliverables, and target completion dates based on leadership direction and the outcome of the review.
• Tracks corrective actions, process changes, system corrections, coding updates, education, rebilling activities, workflow changes, and other remediation efforts through completion.
• Follows up with responsible stakeholders regarding outstanding actions, unresolved concerns, and missed completion dates.
• Performs follow-up reviews to validate that corrective actions were implemented and effectively resolved the identified issue.
• Determines whether additional monitoring, education, auditing, system controls, or process changes are necessary to reduce the risk of recurrence.
• Escalates significant findings, potential risk, recurring issues, unresolved concerns, ineffective corrective actions, and missed remediation commitments to the appropriate leadership.
• Communicates final findings, actions taken, validation results, remaining risk, and closure status to the appropriate stakeholders.
• Ensures reviews are not closed until required actions have been completed, resolution has been validated, and the final outcome has been documented.
• Develops and maintains standardized review procedures, investigation tools, tracking methods, documentation requirements, report templates, and closure criteria.
• Recommends procedural improvements, system controls, workflow changes, monitoring activities, audit opportunities, and education based on review findings.
• Supports implementation of approved process improvements and monitors whether changes produce the intended result.
• Serves as a Coding Operations resource regarding professional coding, documentation, billing, reimbursement, payer requirements, audit methodology, operational workflows, and issue resolution.
• Presents findings and recommendations to providers, administrative leaders, Coding leadership, and other stakeholders as appropriate.
• Maintains complete, accurate, timely, objective, and defensible documentation supporting each review and its final disposition.
• Maintains current knowledge of coding guidance, payer policies, reimbursement requirements, regulatory updates, documentation standards, and industry changes.
• Maintains the confidentiality and security of patient, provider, employee, and business information.
• Meets established quality, productivity, documentation, and turnaround-time expectations.
• Assists with special projects and other coding, audit, reimbursement, system, workflow, or operational reviews as assigned.

Qualifications

• High school diploma or equivalent required; a four-year degree in Health Information Management, Healthcare Administration, Business, Finance, Nursing, or a related field is preferred. An equivalent combination of relevant education and experience may be considered.
• Minimum of seven years of relevant experience in professional fee coding, coding audit, billing compliance, reimbursement, healthcare operations, or related revenue cycle functions required.
• Minimum of three years of professional fee coding audit or complex coding review experience required.
• Experience must include independently reviewing medical records, determining findings, researching coding or payer guidance, documenting conclusions, and communicating findings to leadership or other stakeholders.
• Demonstrated experience conducting investigations, performing root-cause analysis, validating findings, preparing written reports, coordinating with cross-functional stakeholders, and tracking issues through resolution required.
• Experience reviewing multiple professional fee specialties is required.
• Experience in medical oncology, infusion, surgery, radiation oncology, evaluation and management services, and other oncology-related specialties is preferred.
• Strong knowledge of CPT, HCPCS, ICD-10-CM, Evaluation and Management services, modifiers, medical necessity, provider documentation requirements, payer billing requirements, CMS guidance, NCCI edits, LCDs, NCDs, and professional fee reimbursement required.
• Experience with coding and billing systems, electronic medical records, practice management systems, claim information, data analysis, and operational workflows required.
• Experience supporting government, regulatory, payer, risk-based, focused, validation, or other complex reviews preferred.

Licenses & Certifications

Current professional coding certification required. Accepted primary credentials include:

• Certified Professional Coder (CPC)
• Certified Coding Specialist-Physician-based (CCS-P)
• Certified Outpatient Coder (COC)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)

A current auditing credential is also required. Accepted auditing credentials include:

• Certified Professional Medical Auditor (CPMA)
• Certified Healthcare Auditor (CHA)
• Equivalent nationally recognized healthcare coding audit credential, subject to organizational approval

Candidates holding CPC, CCS-P, or COC must also possess an active auditing credential. A general inpatient-focused CCS credential alone does not satisfy the professional fee coding credential requirement. Credential combinations that demonstrate both professional fee coding expertise and formal auditing competency are preferred (e.g., CPC + CPMA, CCS-P + CPMA, COC + CPMA, or RHIA/RHIT with a professional fee coding credential and CPMA). All required credentials must be active and in good standing at the time of hire and maintained throughout employment.

Schedule

Monday through Friday, 8:00 a.m. – 5:00 p.m.