Physician Coder CQA Ambulatory

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.  

** Don't quite meet the above requirements? Check out some of our other Coder positions!

POSITION SUMMARY

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.

CORE FUNCTIONS

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 coding practices and ethical coding compliance. If applicable, initiates and follows through on attending physician queries to ensure that the clinical documentation supports the patient’s treatment and outcomes. Identifies training needs for medical and coding staff. Provides written updates and spreadsheets as to data findings. Serves as a team member for internal coding accuracy audits.

4. Acts as a knowledge resource to Physician Practice Operations, clinical departments and revenue integrity teams regarding charge related issues, processes and programming. Participates in company-wide quality teams’ initiatives to improve clinical documentation. Partners with Documentation and Coding Education team for training Coding operations staff. Assists in creating a department-wide focus of performance improvement and quality management. Assists and participates with management through committees to properly educate physicians, nursing, and coders with proper and accurate documentation for positive outcomes.

5. Researches coding discrepancies and coding trends of inpatient and/or outpatient charge capture to assure the use of proper diagnostic and procedure code assignments. Tracks and creates various reports for leadership to identify coding anomalies, possible gaps in charge capture, potential revenue optimization, and opportunities for staff education. Provides findings for use as a basis for development of Physician Billing compliance plans, education of clinical coding staff and functional assessments.

6. Maintains a current knowledge in all coding regulatory updates. Including Teaching Physician guidelines, Provider Based Clinic rules, billable services for Non-Physician Practitioners, Medicare Local/National Coverage Determinations, and the Office of Inspector General Work Plan. Additionally, identifies future regulatory changes and assists with change management planning; to include, assisting with training for all applicable stakeholders as well as applicable system changes.

7. Serves as a resource for designing, testing and implementing workflows, including upstream and downstream effects in the revenue cycle process. Works with multiple teams within the organization, including Registration, EDI, Revenue Integrity, Clinical Informatics, and Coding Education.

8. Acts as Physician coding liaison to clinical informatics team. Participates in the design, testing and implementation of applicable EHR and billing software changes, the applicable interfaces and reporting.

9. Works independently under limited supervision. Uses an expert level of knowledge to provide billing guidance and oversight for one or more medical facilities. Internal customers include but are not limited to medical staff, employees, patients, and management at the local, regional, and corporate levels. External customers include but are not limited to, practicing physicians, vendors, and the community.

MINIMUM QUALIFICATIONS

Requires a level of education as normally demonstrated by a bachelor’s degree in Health Information Management or experience equivalent to the same, and current continuing education.

In an ambulatory and professional care setting, requires Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other qualified coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).

Demonstrated proficiency in hospital and/or multiple physician specialty coding as normally obtained through 5 years of current and progressively responsible coding experience required.

Must possess a thorough knowledge of ICD-10 coding and/or CPT coding principles, as recommended by the American Academy of Professional Coders or American Health Information Management Association coding competencies. Requires an in-depth knowledge of medical terminology, anatomy and physiology, plus a thorough understanding of the content of the clinical record. Extensive knowledge of all coding conventions and reimbursement guidelines across all services lines.

Extensive critical and analytical thinking skills required. Ability to organize workload to meet deadlines and maintain confidentiality. Excellent written and oral communication skills are required, as well as effective human relations skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts.

Must consistently demonstrate the ability to understand the Medicare, Physician Fee Schedule and the clinical coding data base and indices, and must be familiar with coding and abstracting software, claims processing tools, as well as common office software and the electronic medical records software.

PREFERRED QUALIFICATIONS

Additional related education and/or experience preferred.

EEO/Disabled/Veterans

Our organization supports a drug-free work environment.

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