Certified Radiation Oncology Coder
The Certified Radiation Oncology Coder is responsible for accurate coding, charge capture, and compliance related to professional and technical services provided within the radiation oncology department. This role ensures that clinical documentation is translated into appropriate CPT, HCPCS, and ICD-10 codes in accordance with regulatory guidelines, payer policies, and departmental standards. The coder works closely with physicians, physicists, dosimetrists, therapists, and revenue cycle teams to optimize reimbursement, maintain compliance, and support efficient revenue cycle operations.
Essential Functions
- Review clinical documentation and treatment records to assign accurate CPT, HCPCS, and ICD-10-CM codes for radiation oncology services.
- Code professional and technical services including simulation, treatment planning, dosimetry, treatment delivery, image guidance, and on-treatment visits.
- Ensure correct coding for complex treatment modalities such as IMRT, SBRT, SRS, brachytherapy, and adaptive radiotherapy when applicable.
- Verify charges for treatment management codes and appropriate frequency of billing.
- Review and reconcile charge capture reports to ensure all services are billed appropriately.
- Secures authorization and certification for patient services and verifies third-party insurance coverage and benefits for Radiation Oncology patients.
- Other duties as assigned by supervisory / management staff of the department.
- Maintain an accuracy rate minimally consistent with CMS regulations and internal reimbursement expectations - Accuracy rate of not less than 95% based on internal performance improvement reviews.
Competencies:
- Collaborate with billing teams to resolve claim edits, denials, and coding-related payer inquiries.
- Provide coding clarification to revenue cycle and compliance teams.
- Assist with root-cause analysis of denials related to coding or documentation issues.
- Support optimization of reimbursement through proper charge capture and coding accuracy.
- Provide guidance to physicians and clinical staff on documentation best practices for radiation oncology coding.
- Understanding of Medicare, commercial payer, and radiation oncology billing rules
- Stay current with changes in CPT, HCPCS, ICD-10, Medicare regulations, and payer policies.
- Participate in departmental initiatives to improve coding workflows, compliance, and revenue integrity.
- Strong knowledge of radiation oncology procedures, workflows, and terminology
- Strong attention to detail and analytical skills
- Ability to interpret clinical documentation and complex treatment plans
- Excellent communication and collaboration skills
- Proficiency in electronic health records and billing systems
Education:
High school diploma or equivalent required
Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, or related field preferred
One or more of the following:
- CPC (Certified Professional Coder) American Academy of Professional Coders
- CCS (Certified Coding Specialist) American Health Information Management Association
Experience:
Minimum 23 years of medical coding experience required
Radiation oncology coding experience strongly preferred
Experience with electronic health records and oncology information systems preferred
Minimum Certifications, Registration or License Requirements:
CPC or CCS required.
Work Shift
Workday Day (United States of America)
Worker Sub Type
Regular
Employee Entity
Thomas Jefferson University Hospitals, Inc.
Primary Location Address
111 S 11th Street, Philadelphia, Pennsylvania, United States of America