Sr. Medical Coding Educator

The US Oncology Network•Richardson, TX

12d

About The Position

The US Oncology Network is seeking a Senior Medical Coding Educator for Texas Oncology’s Revenue Cycle Department. This senior-level position supports complex reviews and investigations involving professional coding, documentation, billing, reimbursement, systems, workflows, and operational processes. The role evaluates reported concerns objectively, establishes review scope and methodology, investigates potential root causes and impact, and develops evidence-based findings and recommendations. The position coordinates with Coding Operations, Audit Operations, Education, Operations, Revenue Cycle, Information Technology, Compliance, reimbursement, clinical leadership, providers, and other stakeholders. It documents findings, tracks corrective actions through completion, validates whether remediation was effective, and communicates outcomes and remaining risks. The role also contributes to standardized investigation procedures and process improvements, serves as a Coding Operations resource, and maintains current knowledge of coding, payer, reimbursement, regulatory, and documentation requirements. The position is full-time and based at the listed Richardson, Texas location, with work performed in an office or remote environment. The typical work week is Monday through Friday, 8:00 a.m. to 5:00 p.m. Periodic flexibility in work hours and minimal automobile travel to other US Oncology locations may be required.

Requirements

High school diploma or equivalent required; an equivalent combination of relevant education and experience may be considered.
At least seven years of relevant experience in professional fee coding, coding audit, billing compliance, reimbursement, healthcare operations, or related revenue cycle functions.
At least three years of professional fee coding audit or complex coding review experience, including independent medical record review, determining findings, researching coding or payer guidance, documenting conclusions, and communicating findings.
Demonstrated experience conducting investigations, root-cause analysis, and validation; preparing written reports; coordinating with cross-functional stakeholders; and tracking issues through resolution.
Experience reviewing multiple professional fee specialties.
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.
Experience with coding and billing systems, electronic medical records, practice management systems, claim information, data analysis, and operational workflows.
Current professional coding certification required. Accepted primary credentials include CPC, CCS-P, COC, RHIA, or RHIT.
A current auditing credential is required. Accepted credentials include CPMA, CHA, or an equivalent nationally recognized healthcare coding audit credential subject to organizational approval. Candidates holding CPC, CCS-P, or COC must also have an active auditing credential.
All required credentials must be active and in good standing at hire and maintained, including continuing education requirements, throughout employment.
Ability to assess issues across coding, documentation, billing, reimbursement, systems, workflows, operations, quality, and compliance-risk perspectives, and to investigate and validate evidence before drawing conclusions.
Ability to determine review scope, identify potentially affected populations, distinguish isolated errors from broader trends or risks, interpret applicable guidance and evidence, and identify when other stakeholders or subject-matter experts are needed.
Ability to manage multiple complex reviews independently, meet deadlines, coordinate cross-functional work without direct supervisory authority, track corrective actions, validate effectiveness, and close reviews appropriately.
Strong analytical, investigative, organizational, critical-thinking, written and verbal communication, follow-up, and problem-solving skills; strong attention to detail.
Ability to work independently and proactively with urgency and tact, manage competing priorities, exercise sound judgment and objectivity, protect confidentiality, and escalate concerns appropriately.
Proficiency with Microsoft Outlook, Word, Excel, and PowerPoint.

Nice To Haves

Four-year degree in Health Information Management, Healthcare Administration, Business, Finance, Nursing, or a related field.
Experience in medical oncology, infusion, surgery, radiation oncology, Evaluation and Management services, and other oncology-related specialties.
Experience supporting government, regulatory, payer, risk-based, focused, validation, or other complex reviews.
Credential combinations demonstrating both professional fee coding expertise and formal auditing competency, such as CPC and CPMA, CCS-P and CPMA, COC and CPMA, or RHIA/RHIT with a professional fee coding credential and CPMA.
Oncology, surgical, Evaluation and Management, compliance, clinical documentation, or specialty-specific credentials.
Experience with Power BI, Microsoft Lists, Access, audit software, electronic health records, practice management systems, claims systems, or other workflow and reporting tools.

Responsibilities

Conduct complex reviews and investigations involving coding, documentation, billing, reimbursement, systems, workflows, operational processes, and quality concerns.
Receive and evaluate review requests and establish an appropriate scope and methodology based on the concern, risk, available information, and affected services or processes.
Review medical records, provider documentation, coding, charges, claims, billing activity, system configuration, workflows, policies, procedures, and supporting data.
Determine whether concerns stem from coding, documentation, billing, reimbursement, payer requirements, systems, workflows, process design, training, staff or provider activity, or a combination of factors.
Conduct focused audits, medical record and claim reviews, data and coding validation, and other investigative work needed to confirm concerns and determine their scope.
Research CPT, HCPCS, ICD-10-CM, CMS, Medicare Administrative Contractor, NCCI, payer, regulatory, and organizational guidance.
Identify potentially affected populations, time frames, specialties, providers, locations, claims, charges, or workflows, and assess potential coding, financial, operational, reimbursement, and compliance impact.
Document investigative steps, evidence, findings, root cause, scope, impact, recommendations, and final disposition; ensure conclusions are supported by appropriate evidence and guidance.
Prepare reports of findings and recommendations and present them to Coding leadership, providers, administrative leaders, and other stakeholders as appropriate.
Identify patterns, trends, control weaknesses, system issues, documentation deficiencies, coding concerns, billing risks, workflow barriers, and recurring operational problems.
Coordinate with relevant departments and subject-matter experts, facilitate stakeholder communication, and clarify responsibilities and dependencies.
Develop or recommend corrective actions; document owners, actions, deliverables, and target dates based on leadership direction and review outcomes.
Track corrective actions and remediation efforts through completion, follow up on outstanding or missed actions, and escalate significant or unresolved concerns to appropriate leadership.
Perform follow-up reviews to validate that corrective actions were implemented and effectively resolved the issue; determine whether additional monitoring, education, auditing, controls, or process changes are needed.
Communicate final findings, actions taken, validation results, remaining risk, and closure status; ensure reviews are closed only after required actions and validation are complete and documented.
Develop and maintain standardized review procedures, investigation tools, tracking methods, documentation requirements, report templates, and closure criteria.
Recommend procedural improvements, system controls, workflow changes, monitoring activities, audits, and education, and support approved improvements and monitor their results.
Serve as a Coding Operations resource on professional coding, documentation, billing, reimbursement, payer requirements, audit methodology, workflows, and issue resolution.
Maintain complete, accurate, timely, objective, and defensible review documentation and current knowledge of coding, payer, reimbursement, regulatory, documentation, and industry changes.
Protect confidential patient, provider, employee, and business information; meet quality, productivity, documentation, and turnaround expectations; and assist with assigned special projects and reviews.