Experienced Professional Coding Specialist

OU Health•WFH State of Oklahoma, OK

About The Position

The Experienced Professional Coding Specialist independently performs complex professional coding across multiple specialties and care settings, including office and clinic, hospital outpatient, emergency and urgent care, ambulatory surgery center, skilled nursing and nursing home, and telehealth. The role applies advanced coding judgment, payer policy interpretation, and documentation standards to support compliant reimbursement, work relative value unit (wRVU) integrity, and audit defensibility in an academic and research enterprise. The position supports charge review coding for adult and pediatric evaluation and management services and minor procedures, resolves coding-related denials, and works with leadership to develop processes that reduce denials. The specialist also provides peer guidance, participates in quality reviews, and helps identify documentation improvement opportunities. Remote candidates must reside and work full-time in Arkansas, Kansas, Missouri, Oklahoma, or Texas before their first day; remote or hybrid work options are mentioned.

Requirements

High school diploma or GED.
At least 3 years of physician/provider coding experience.
One of the following certifications or credentials: RHIA, RHIT, CCS, CPC, or CIC.
Advanced expertise in ICD-10-CM, CPT, HCPCS, and modifiers.
Strong evaluation and management coding proficiency and payer policy interpretation skills.
Proficiency in Epic professional coding work queues and encoder tools.
Ability to review EHR documentation across multiple settings.
Analytical problem-solving skills for denial and edit prevention.
Working knowledge of risk adjustment concepts and HCC validation where applicable.
Must reside and work full-time in Arkansas, Kansas, Missouri, Oklahoma, or Texas before the first day of employment for remote eligibility.

Responsibilities

Code complex professional encounters and procedures, ensuring correct sequencing, modifiers, evaluation and management level selection, and alignment with documentation.
Resolve coding-related edits and denials by identifying root causes, coordinating documentation clarification, and supporting rebilling actions when applicable.
Apply payer medical policies, NCCI concepts, global service considerations, and telehealth coding rules to professional fee claims as relevant.
Provide real-time guidance to peers on standard coding scenarios and promote consistency by sharing best practices.
Participate in internal quality review programs and implement education or corrective actions based on findings.
Review documentation efficiently in the EHR across settings using Epic professional coding work queues and encoder tools.
Analyze denial and edit trends, identify prevention opportunities and documentation improvement opportunities, and support compliant query workflows.
Apply working knowledge of risk adjustment concepts and HCC validation where applicable to supported populations.
Perform other duties as assigned.