Coder Quality Associate Phys Practice

Banner Health•Show Low, AZ

18h•$30 - $49•Remote

About The Position

The Coder Quality Associate is responsible for interpreting clinical documentation in health records and ensuring alignment between documentation and billing codes. This quality-focused role is not a day-to-day coding production position, but requires current professional and ambulatory physician coding proficiency. The associate works with medical staff and quality management staff to improve clinical documentation and ensure accurate billing codes before claims are submitted to third-party payers. The role addresses complex denials, identifies coding trends, supports denial prevention, and helps maintain quality in the Ambulatory Coding department. The associate audits records for coding accuracy and compliance, monitors coding work and trends, and provides education and guidance to coders and other stakeholders. The role also researches coding discrepancies, reports findings and potential improvement opportunities, supports coding policies and regulatory updates, and collaborates across revenue cycle, clinical, and informatics teams. The position works independently under limited supervision and provides billing guidance and oversight for one or more medical facilities. This is a fully remote position, available only to candidates who live in the listed eligible states: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, or WY.

Requirements

Bachelor’s degree in Health Information Management or equivalent experience, with current continuing education.
Active coding certification through AHIMA or AAPC, such as CCS, CPC, CCS-P, RHIT, RHIA, or another qualified coding certification.
Five years of current and progressively responsible coding experience in an ambulatory and professional care setting; demonstrated proficiency in hospital and/or multiple physician specialty coding.
Thorough knowledge of ICD-10 and/or CPT coding principles and coding competencies.
In-depth knowledge of medical terminology, anatomy and physiology, and clinical records.
Extensive knowledge of coding conventions and reimbursement guidelines across service lines.
Strong critical and analytical thinking skills; ability to organize workload, meet deadlines, and maintain confidentiality.
Excellent written and oral communication skills and effective human relations skills to build working relationships across staff levels and with physicians and other contacts.
Ability to apply knowledge of Medicare, the Physician Fee Schedule, and clinical coding databases and indices.
Familiarity with coding and abstracting software, claims processing tools, common office software, and electronic medical record software.
Must reside in one of the listed eligible states for this fully remote position.

Nice To Haves

Additional related education and/or experience.

Responsibilities

Provide coding guidance for non-standard billing and explain professional fee coding guidelines and their reimbursement impact.
Research authoritative references and provide information to internal and external customers about clinical documentation.
Audit medical records to ensure accurate clinical coding, appropriate reimbursement, and coding compliance.
Apply CMS, CPT, ICD-10, and NCCI guidelines to assign diagnoses and procedures, including combination codes, sequencing rules, and global or bundled CPT codes.
Monitor coding work and trends and provide education when opportunities are identified.
Help maintain consistent coding practices and ethical coding compliance across the system.
Initiate and follow through on attending physician queries, when applicable, to ensure documentation supports patient treatment and outcomes.
Identify training needs for medical and coding staff; prepare written updates and spreadsheets on findings; and participate in internal coding accuracy audits.
Advise Physician Practice Operations, clinical departments, and revenue integrity teams on charge-related issues, processes, and programming.
Participate in quality initiatives to improve clinical documentation and partner with the Documentation and Coding Education team to train coding operations staff.
Support performance improvement and quality management, including physician, nursing, and coder education on accurate documentation.
Research coding discrepancies and trends in inpatient and/or outpatient charge capture and verify proper diagnostic and procedure code assignments.
Create and track reports for leadership on coding anomalies, charge capture gaps, potential revenue optimization, and staff education opportunities.
Maintain current knowledge of coding regulatory updates, including Teaching Physician guidelines, Provider Based Clinic rules, services billable by Non-Physician Practitioners, Medicare Local/National Coverage Determinations, and the Office of Inspector General Work Plan.
Identify future regulatory changes and assist with change management, stakeholder training, and applicable system changes.
Help design, test, and implement revenue-cycle workflows, considering upstream and downstream effects, in collaboration with Registration, EDI, Revenue Integrity, Clinical Informatics, and Coding Education teams.
Serve as the physician coding liaison to the clinical informatics team and participate in designing, testing, and implementing relevant EHR and billing software changes, interfaces, and reporting.
Work independently under limited supervision and provide billing guidance and oversight for one or more medical facilities.