[Hiring] Radiology Coder/Auditor @SMI IMAGING LLC

Role Description

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 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.

Qualifications

• 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.

Requirements

• 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.

Company Description