Primary City/State:
Phoenix, Arizona
Department Name:
Clinical Performance Improveme
Work Shift:
Day
Job Category:
Risk, Quality and Safety
You have a place in the health care industry. If you're looking to leverage your abilities to make a real difference - and real change in the health care industry - you belong at Banner Health. Apply today.
The Risk Adjustment team strives to provide best in class risk adjustment education to our provider community. The Clinical Risk Adjustment Educator is a key role in this success. You will work closely with internal teams as well as the provider network.
Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY
This position, using a combination of data and chart reviews, identifies patterns in provider coding. Implements when necessary, education to providers and their staff to remediate areas of low performance. This position assists with the delivery of education/training materials, conducts and coordinates training and development of providers and their office staff. Provides technical training in coding, risk adjustment, documentation, and billing functions.
CORE FUNCTIONS
1. Conducts medical record reviews to evaluate documentation to ensure that diagnosis coding meets specificity requirements to support clinical indicators.
2. Query providers regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the heath record.
3. Compiles data and recommends solutions regarding trends or patterns noticed in provider coding. Provides formal training to providers and staff regarding coding, billing and documentation standards related to risk adjustment activity.
4. Assists, with concurrent coding to meet departmental goals/deadlines. Maintains a 96% quality audit accuracy rate.
5. Performs prospective, concurrent, and retrospective chart reviews based on department needs/goals.
6. Assists with research and analysis for inquiries regarding compliance, coding, and inappropriate documentation.
7. Performs the minimum number of coding quality reviews consistent with established departmental goals. Maintains strictest confidentiality based on HIPAA privacy policy.
8. Maintains current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10-CM book, CMS manuals, by attending educational workshops/conferences, reviewing professional publications, establishing personal networks, and/or participating in professional societies. This may also include performing ongoing research to ensure compliance with clinical documentation and/or regulatory guidelines and standards.
MINIMUM QUALIFICATIONS
Must possess a current knowledge of business and/or healthcare as normally obtained through completion of a bachelor's degree in healthcare administration or related field or possess equivalent experience.
This position requires a credential such as Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT) or Certified Coding Specialist (CCS) in an active status with the American Health Information Management Association (AHIMA) or a Certified Professional Coder (CPC) with active status with the American Academy of Professional Coders (AAPC). A valid Driver's license and ability to drive to assigned practices. Must be well versed in regulatory requirements for ICD-10-CM Coding Guidelines, medical record documentation, as well as Medical Staff Rules and Regulations where applicable.
Requires the knowledge typically acquired over four or more years of work experience in risk adjustment. Medical terminology, anatomy and physiology, and disease pathology knowledge is required.
Must be able to function as part of a team, using effective interpersonal and instructional skills. Must possess excellent written, verbal, and customer service skills, and have the ability to conduct educational needs analysis and to teach effectively to a wide range of comprehension levels.
Must be proficient in the use of common office and presentation software and have an advanced knowledge and experience with computer healthcare applications and hardware.
PREFERRED QUALIFICATIONS
Previous training/teaching experience and customer service education experience preferred.
Creativity and knowledge of adult learning principals preferred.
Hold the Certified Risk Adjustment Coder (CRC) credential or similar specialty credential.
Additional related education and/or experience preferred.
