Job Summary:

We are seeking a detail-oriented and experienced Coding Quality Assurance (QA) Specialist with a strong background in Interventional Radiology (IR). This role ensures the accuracy, completeness, and compliance of coding practices. The specialist plays a critical part in identifying trends, minimizing revenue leakage, and supporting coder development through audits and feedback.

Key Essential Functions and Tasks:

- Conduct routine and focused audits on IR encounters to ensure adherence to coding guidelines, payer requirements, and internal policies.

- Validate CPT, ICD-10-CM, and HCPCS codes for IR procedures (e.g., vascular access, embolization, biopsies, drainage).

- Analyze audit results and provide detailed, constructive feedback to coders.

- Identify error trends and deliver targeted training or refresher sessions as needed.

- Collaborate with coding managers, providers, and compliance teams to resolve documentation or coding issues.

- Stay current on industry standards (AAPC, AHIMA, CMS, AMA) and payer-specific updates relevant to IR.

- Maintain thorough audit records and contribute to monthly QA and coding accuracy reports.

- Support pre-bill reviews and serve as a resource for complex IR coding questions.

- Assist in developing and refining QA tools and checklists tailored for IR coding audits.

Education and Experience Requirements:

- Bachelors degree in a Life Science or healthcare-related field.

- CIRCC certification (Certified Interventional Radiology Cardiovascular Coder) - Required.

- Minimum 3 years of medical coding experience, including 2 years specific to Interventional Radiology.

- Prior experience in coding quality auditing or training is strongly preferred.

Knowledge, Skills, and Abilities:

- Expert knowledge of ICD-10-CM, CPT, and HCPCS coding systems.

- Strong grasp of medical terminology, IR-specific anatomy, physiology, and clinical procedures.

- High level of accuracy and strong analytical thinking.

- Excellent communication and interpersonal skills for cross-functional collaboration.

- Proficiency in coding platforms, EHR systems, and audit software/tools.

- Ability to manage multiple priorities in a deadline-driven environment.

- Self-motivated with the ability to work independently.