Physician Coder CQA Ambulatory

Department Name:
Coding Ambulatory

Work Shift:

Day Job Category:
Revenue Cycle A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities – you belong at Banner Health.

In this Physician Coder Quality Associate position, you bring your 5 years of Ambulatory Physician coding experience to a team who resolves complex denials, identifies trends, and provides solutions to help support mid-revenue cycle. This is a Quality position, not a day-to-day coding production role, but does require coding proficiency and recent Physician Ambulatory/Professional Coding experience. This position is task-solution-oriented ensuring quality in the Ambulatory Coding department and allows opportunity for coaching fellow coders through different aspects of Ambulatory Coding and denial prevention.

5 years current experience in Ambulatory Physician-based coding;
Bachelors degree in HIMS or equivalent;
Must be Certified Coder through AAPC or AHIMA, as defined in minimum qualifications. This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, , IN, KS, KY, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI & WY.

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.

This position is responsible for the interpretation of clinical documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. Works with medical staff and quality management staff to correctly align diagnosis documentation and billing coding to improve the quality of clinical documentation and correctness of billing codes prior to claim submission to third party payers;

to identify possible opportunities for improvement of clinical documentation and accurate MS-DRG, Ambulatory Payment Classification (APC) or ICD-9 assignments on health records. Provides guidance and expertise in the interpretation of, and adherence to, the rules and regulations for documentation.

• 1. Provides coding and guidance for non-standard billing. Demonstrates extensive knowledge of Professional Fee Coding Guidelines/Policies and their impact on appropriate reimbursement from Medicare/Medicaid and third-party payers. Provides explanatory and reference information to internal and external customers regarding clinical documentation which may require researching authoritative reference information from a variety of sources.
• 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper reimbursement and that coding compliance is complete. Monitors coding work and trends, then provides education where opportunities are identified. Applies Centers for Medicare/Medicaid Services (CMS), CPT, ICD-10, and NCCI guidelines to select the appropriate diagnosis, including combination codes and sequencing rules, as well as the appropriate procedure, identifying global or bundled CPT codes.
  
  Apply policies and procedures on health documentation and coding that are consistent with official coding guidelines.
• 3. Assists with maintaining system wide consistency in…