Job Duties:
- Assign accurate ICD-10-CM, CPT, HCPCS, and modifier codes, including radiopharmaceutical/tracer HCPCS coding (e.g., A-codes, Q-codes) and dosage-based unit calculation for PET and Nuclear Medicine studies, in in accordance with AMA, CMS, payer-specific, and regulatory coding guidelines, ensuring the highest level of specificity supported by clinical documentation.
- Review and process encounters from assigned coding, audit, and denial work queues, completing or reassigning work as appropriate.
- Conduct quality assurance audits of radiology encounters coded by third-party coding vendors and AI-assisted coding platforms, against defined accuracy benchmarks.
- Evaluate coding accuracy, consistency, compliance, and proper application of MIPS quality measures.
- Identify, analyze, and correct coding discrepancies, denials, claim rejections, and documentation-related issues.
- Monitor coding performance trends and prepare reports highlighting coding effectiveness, error patterns, audit findings, and areas of risk.
- Provide detailed feedback and recommendations to coding leadership regarding vendor performance, AI tool performance, training needs, and process improvement opportunities.
- Review provider documentation to determine coding completeness and compliance and communicate documentation improvement opportunities to leadership.
- Collaborate with cross-functional teams to support revenue cycle optimization, coding education, and audit initiatives.
- Maintain current knowledge of coding regulations, payer requirements, and industry best practices impacting radiology and Nuclear Medicine/PET services.
- Escalate audit findings involving potential compliance risk, billing integrity concerns, or regulatory exposure per company policy to coding leadership.
- Ensure compliance with all departmental policies, organizational standards, regulatory requirements, and confidentiality guidelines.
- Participate in special projects, training initiatives, and ongoing quality improvement activities as assigned.
Education and Experience:
- Bachelor's degree preferred; equivalent combination of education and relevant experience may be considered.
- Minimum of 5 years of recent radiology coding experience required, including experience coding PET and/or Nuclear Medicine studies.
- Certified Professional Coder (CPC) or Radiology Certified Coder (RCC) required.
- Certified Professional Medical Auditor (CPMA) preferred.
- Radiology Certified Coder-Interventional Radiology (RCC-IR) preferred.
- Demonstrated experience performing coding audits and quality assurance reviews.
- Experience reviewing and resolving coding-related denials and claim rejections.
- Experience working with coding vendors, outsourced coding teams, or quality review programs preferred.
- Experience with AI-assisted coding platforms, including Aideo and/or Gemini, preferred.
Knowledge, Skills, and Abilities:
- Advanced knowledge of radiology coding, compliance, and reimbursement methodologies
- Advanced knowledge of PET and Nuclear Medicine coding, including radiopharmaceutical/tracer billing (HCPCS A-codes and Q-codes), dosage-based unit calculation, and payer-specific coverage requirements.
- Working knowledge of Medicare National and Local Coverage Determinations (NCD/LCD) relevant to PET imaging, including medical necessity documentation requirements.
- Ability to distinguish and correctly code professional vs. technical component billing in outpatient Nuclear Medicine and PET/CT fusion studies.
- Strong auditing and analytical skills
- Experience evaluating coding accuracy across both human and AI-assisted workflows
- Ability to deliver structured feedback and training to an offshore coding team, including calibration sessions and documented coaching or scorecard mechanisms.
- Attention to detail with a commitment to quality and accuracy
- Excellent written and verbal communication skills
- Ability to identify trends and provide actionable recommendations
- Strong organizational and time-management skills
- Proficiency with revenue cycle and coding technology platforms
Please note this job description is not designed to contain a comprehensive list of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without prior notice.
Requires 5+ years of recent radiology coding experience including PET or Nuclear Medicine, CPC or RCC, audit experience, denial resolution, advanced coding knowledge, and strong analytical and communication skills.
Key Responsibilities
- assigning codes
- auditing encounters
- analyzing discrepancies
Skills & Tools
ICD-10-CM, CPT, HCPCS, Aideo, Gemini, MIPS
Job Details
- Category: Healthcare Services - Allied Health
- Seniority: Senior Level
- Commitment: Full Time
- Workplace: Remote — Scottsdale, Arizona, United States
- Languages: English
Benefits
- 401k matching
- Generous paid time off
- Tuition reimbursement
- Retirement plan
About SimonMed Imaging
A healthcare organization providing radiology services and revenue cycle operations. — Industry: Healthcare