Physician Coder, CQA, Ambulatory

This is a fully remote position, open to applicants in Alaska, +30 more states.

📋 Description

• Analyze clinical documentation and ensure alignment with billing codes to uphold quality assurance.

• Collaborate with medical personnel and quality management teams to enhance the accuracy of clinical documentation and billing codes prior to claim submissions.

• Offer coding support and guidance for non-standard billing and professional fee coding.

• Conduct research using authoritative coding and reimbursement resources.

• Examine medical records and audit clinical documentation for compliance and coding accuracy.

• Observe coding practices and trends, providing education when opportunities for improvement arise.

• Implement CMS, CPT, ICD-10, and NCCI guidelines in the selection of diagnosis and procedure codes.

• Initiate and manage queries to attending physicians when necessary.

• Recognize training requirements for medical and coding personnel.

• Deliver written updates, spreadsheets, reports, and data insights.

• Engage in internal coding accuracy audits and company-wide quality initiatives.

• Counsel operations, clinical departments, and revenue integrity teams on charge-related matters.

• Collaborate with Documentation and Coding Education for staff training purposes.

• Investigate coding discrepancies and trends in inpatient and/or outpatient charge capture.

• Monitor coding anomalies, gaps in charge capture, opportunities for revenue optimization, and training needs for staff.

• Stay informed about coding regulatory updates and assist with change management planning.

• Design, test, and implement workflows for revenue cycles and modifications to EHR and billing software.

• Serve as the physician coding liaison to the clinical informatics team.

• Operate independently under minimal supervision while providing billing guidance for medical facilities.

⛳️ Requirements

• A minimum of 5 years of recent experience in Ambulatory Physician-based coding.

• Bachelor’s degree in Health Information Management or equivalent professional experience.

• Commitment to ongoing education.

• Active CCS, CPC, CCS-P, RHIT, RHIA, or another recognized coding certification from AHIMA or AAPC.

• Expertise in hospital and/or multiple physician specialty coding.

• Comprehensive understanding of ICD-10 and/or CPT coding principles.

• Profound knowledge of medical terminology, anatomy and physiology, and clinical records.

• Extensive familiarity with coding conventions and reimbursement guidelines across various service lines.

• Strong critical and analytical thinking abilities.

• Capability to organize workload, meet deadlines, and uphold confidentiality.

• Exceptional written and verbal communication skills.

• Knowledge of Medicare, Physician Fee Schedule, clinical coding databases, and indices.

• Proficient with coding and abstracting software, claims processing tools, standard office software, and electronic medical records software.

• Must reside in one of the eligible states: Alaska, Arkansas, Arizona, California, Colorado, Florida, Georgia, Iowa, Idaho, Indiana, Kansas, Kentucky, Michigan, Minnesota, Missouri, Mississippi, North Carolina, North Dakota, Nebraska, New Mexico, Nevada, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, or Wyoming.

🏝️ Benefits

• Options for remote work.

• Fully remote position available.

• Opportunities for career and lifestyle choices.

• Continuing education support.

• A drug-free workplace environment.