Risk Adjustment Coding Reviewer

Department Name: Risk Adjustment

Work Shift:

Day

Job Category:

Risk, Quality and Safety

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.

As a Risk Adjustment Coding Reviewer, you will conduct prospective and concurrent chart reviews to ensure documentation supports accurate ICD-10 risk adjustment coding and compliance with coding guidelines. You will review clinical documentation, validate supported diagnoses, and work within multiple systems including Cerner, NextGen, and other risk adjustment applications. A key part of the role involves querying providers through compliant documentation clarification processes and delivering education to providers and practice partners on risk adjustment principles, coding accuracy, and documentation best practices. Success in this position requires strong risk adjustment coding knowledge, attention to detail, the ability to learn multiple software platforms, and the motivation to work independently in a highly autonomous remote environment. The ideal candidate will also have demonstrated leadership experience, with a proven ability to influence stakeholders, mentor peers, drive provider engagement, and serve as a trusted resource for coding and documentation best practices.

This is a remote position with a work schedule of Monday - Friday 8am - 5pm. Candidates must live in the state of AZ to be considered.

Banner Health has been recognized by Becker’s Healthcare as one of the 150 top places to work in health care. In addition, we recently made Newsweek’s list of America’s Greatest Workplaces 2023 for Diversity. These recognitions reflect Banner Health's investment in team members' professional development, wellness benefits, and continued education. It highlights our commitment to advocating for diversity in the workplace, promoting work-life balance, and boosting employee engagement

Banner Plans & Networks (BPN) 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 BPN, 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). 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 principles preferred.

Hold the Certified Risk Adjustment Coder (CRC) credential or similar specialty credential.

Additional related education and/or experience preferred.

Estimated Pay Range:

$27.72 - $46.20 / hour Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.

EEO Statement:

EEO/Disabled/Veterans

Our organization supports a drug-free work environment.

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