Description

Responsibilities

• Perform detailed coding for Interventional Radiology procedures, including complex vascular and non‑vascular services
• Apply CPT and HCPCS coding guidelines, conventions, and National Correct Coding Initiative (NCCI) edits
• Ensure accurate and defensible use of modifiers and procedural bundling rules
• Maintain current knowledge of regulatory and reimbursement updates impacting IR and outpatient procedural coding
• Provide general CPT coding coverage for additional procedural specialties based on operational needs
• Participate in internal audits, quality assurance activities, and education initiatives
• Demonstrate initiative, sound judgment, and the ability to reprioritize work based on volume, regulatory changes, and billing deadlines

Required Qualifications

• Must have and maintain at least one of the following professional certifications:
  • CPC
  • CCS
• Minimum of 5 years of experience in interventional radiology CPT‑based procedural coding
• Ability to apply defensible coding practices using recognized sources such as:
  • Official Coding Guidelines
  • CPT Assistant
  • CMS transmittals and manuals
• Strong analytical skills and attention to detail

Description – Internal

• Function as expert in Interventional Radiology and CPT coding.
• Function as CPT subject matter expert (SME) liaison between product, marketing, sales, and SME staff.
• Function as a coding, billing, reimbursement, and regulatory policy SME for Optum Referential Content Team.
• Apply US Billing and Coding expertise in current coding systems (ICD-10-CM/ CPT/HCPCS) and operational expertise to provide up-to-date, clear and concise content for all products.
• Maintain official sources for defensible support for product content.
• Respond to CPT/HCPCS and Medicare questions/queries for internal and external customers.
• Provide Director, SME team members, Product Managers, Sales, and Marketing with information on healthcare industry changes that impact the business.

Responsible for specific services, functions, and solutions available internally or as a supporting element of a product, typically not sold stand-alone externally. Positions in this function play a critical role in ability to deliver products to market and/or manage internal business functions. Capability management requires alignment to business and/or product strategy, effective design and development, and ongoing management of capability portfolio across the full lifecycle to ensure business-specific or cross-enterprise impact. Market insights are leveraged to monitor trends and external landscape, and to inform capability strategies and customer use case scenarios. Positions in this function are accountable for delivering sustainable, financially sound solutions that solve a specific problem and enable successful external product delivery and/or internal business function performance, while driving adoption with internal business clients and define future capability direction that supports business strategy and new opportunities.

• Analyzes and investigates.
• Provides explanations and interpretations within area of expertise.

Qualifications – External

• Undergraduate degree or equivalent experience.
• Must have, and maintain, at least one of the following professional certifications:
  • CCP
  • CCS
• Minimum 5 years outpatient interventional radiology US coding experience,

Ability to apply defensible coding practices using recognized sources such as Official Coding Guidelines; CPT Assistant; CMS transmittals; and CMS manuals

Key Skills

Education

Bachelor's degree