The Senior Clinical Coding Specialist plays a critical role in ensuring the accuracy, integrity, and compliance of coded clinical data that supports patient care, operational performance, and regulatory requirements. The Senior Clinical Coding Specialist reviews complex inpatient medical records, assigns appropriate codes, and serves as a key resource for coded data interpretation and quality initiatives.
The Senior Clinical Coding Specialist is responsible for analyzing medical records, abstracting clinical data, and assigning diagnosis and procedure codes in accordance with established coding classification systems and regulatory guidelines. The Senior Clinical Coding Specialist collaborates with physicians, coding leadership, and operational teams to ensure documentation accuracy and coding compliance while supporting the mission of UT MD Anderson.
The ideal candidate will possess a Bachelor's Degree in Health Information Management, Healthcare Administration, or a related healthcare field, along with professional coding credentials such as RHIA, RHIT, or CCS certification. Candidates should have extensive experience coding complex or multi-specialty clinical records, strong knowledge of inpatient coding methodologies, and expertise in ICD-10-CM/PCS, DRG assignment, compliance standards, and physician query practices.
Minimum $67,000 annually - Midpoint $83,500 annually - Maximum $100,000 annually
Work Location: Remote (within Texas only) -Must come onsite as needed.
Responsibilities
People/Service • Communicate effectively with members of the inpatient coding team, management, peers, business office personnel, and external customers • Provide detailed questions and supportive feedback to management and coordinators regarding coding questions, quality reviews, and education or training needs • Deliver constructive feedback for internal and external coding corrections, edits, and re-review requests • Promptly report workflow concerns and system issues to management
Development/Innovation • Advance professional knowledge through continuing education, coding rounds, seminars, professional literature, and other educational forums • Participate in discussions regarding documentation challenges and coding compliance concerns • Provide feedback regarding potential Coding Clinic updates and coding practice improvements • Actively participate in team meetings and departmental staff meetings
Coding Quality/Protected Health Information • Maintain discharged not final billed thresholds as directed by coding leadership • Apply official coding guidelines, Coding Clinic guidance, and departmental coding policies accurately and consistently • Demonstrate understanding of disease processes, major complications, chronic conditions, and present on admission indicators • Initiate compliant and impactful physician queries when documentation requires clarification • Review and interpret medical record documentation for coding accuracy • Assign accurate MS-DRG, APR-DRG, POA, ICD-10-CM, ICD-10-PCS, and PSI codes for inpatient hospital records • Utilize 3M software, Epic, and coding references to support coding activities • Ensure coding accuracy, completeness, and compliance with applicable standards
Compliance & Data Integrity • Adhere to the Standards of Ethical Coding established by the American Health Information Management Association (AHIMA) • Follow official coding conventions and coding guidelines • Maintain compliance with HIPAA regulations and protected health information requirements • Perform additional business-related duties and responsibilities as assigned
EDUCATION- Required: Associate's Degree Health Information Management, Healthcare Administration, or related healthcare field.
- Preferred: Bachelor's Degree Health Information Management, Healthcare Administration, or related healthcare field.
WORK EXPERIENCE- Required: 5 years Clinical coding experience for complex or multi-specialties. or
- Required: 3 years Clinical coding experience for complex or multi-specialties with preferred degree.
- May substitute required education degree with additional years of equivalent experience on a one to one basis.
LICENSES AND CERTIFICATIONS- Required: RHIA - Registered Health Information Administrator American Health Information Management Association (AHIMA). Upon Hire or
- Required: RHIT - Registered Health Information Technician American Health Information Management Association (AHIMA). Upon Hire or
- Required: CCS-Certified Coding Specialist American Health Information Management Association (AHIMA). Upon Hire or
- Required: CCA - Certified Coding Associate American Health Information Management Association (AHIMA). Upon Hire or
- Required: Certified Coder-AHIMA or AAPC American Academy of Professional Coders (AAPC). Upon Hire or
- Required: CPC-A - Cert Prof Coder-Apprentice American Academy of Professional Coders (AAPC). Upon Hire or
- Required: COC - Certified Outpatient Coding American Academy of Professional Coders (AAPC). Upon Hire
- Preferred: RHIA - Registered Health Information Administrator American Health Information Management Association (AHIMA). Upon Hire or
- Preferred: RHIT - Registered Health Information Technician American Health Information Management Association (AHIMA). Upon Hire or
- Preferred: CCS-Certified Coding Specialist American Health Information Management Association (AHIMA). Upon Hire or
OTHER REQUIREMENTS: Must pass pre-employment skills test as required and administered by Human Resources.
The University of Texas MD Anderson Cancer Center offers excellent benefits, including medical, dental, paid time off, retirement, tuition benefits, educational opportunities, and individual and team recognition.
This position may be responsible for maintaining the security and integrity of critical infrastructure, as defined in Section 113.001(2) of the Texas Business and Commerce Code and therefore may require routine reviews and screening. The ability to satisfy and maintain all requirements necessary to ensure the continued security and integrity of such infrastructure is a condition of hire and continued employment.
