Risk, Quality and Safety 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.
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.
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.
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.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.
MATRIX OR INDIRECT REPORTING
TYPE OF SUPERVISORY RESPONSIBILITIES
Banner Health Leadership will strive to uphold the mission, values, and purpose of the organization. They will serve as role models for staff and act in a people-centered, service excellence-focused, and results-oriented manner.
PHYSICAL DEMANDS/ENVIRONMENT FACTORS OE - Typical Office Environment: (Accountant, Administrative Assistant, Consultant, Program Manager) Requires extensive sitting with periodic standing and walking. May be required to lift up to 20 pounds. Requires significant use of personal computer, phone and general office equipment. Needs adequate visual acuity, ability to grasp and handle objects. Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone. May require off-site travel.
This is not a safety sensitive position.
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.
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.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health.
Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible.
The size, success and growth of our system provide you with the stability and options to pursue your desired career path.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.