Risk Adjustment Coder Educator

Banner Health Phoenix , AZ 85002

Posted 2 days ago

Department Name:

Clinical Performance Improveme

Work Shift:


Job Category:

Risk, Quality and Safety

Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of, we want to hear from you.

As a Risk Adjustment Coder Educator, you will work in a collaborative effort directly with Banner Health Network physicians (both employed and independent) and their office staff to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. You will also help in creating new tools and reports to help physicians and office staff identify risk adjustment coding opportunities for Medicare FFS and Medicare Advantage lives. We are looking for a strong individual with extensive ambulatory and risk adjustment coding experience.

Becoming a member of our Coding team will offer an opportunity for career advancement while working with a fun, energetic, and innovative team. Our leaders offer continuous learning and support. This position has the option of working remotely or at a Peoria, Mesa or central Phoenix Banner locations.

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans 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.


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 the ICD-10-CM code set, Risk Adjustment, documentation, and billing functions. Using a combination of data and chart reviews identify patterns in provider coding. Implement when necessary education to providers and their staff to remediate on areas of low performance.


1.Conducts chart reviews for providers and review provider performance. This is accomplished by traveling to the individual practices and performing side-by-side education.

Evaluates documentation to ensure that diagnosis coding is supported and meets specificity requirement to support clinical indicators. Query providers regarding missing, unclear or conflicting health record documentation by requesting and obtaining additional documentation within the heath record.

2.Develops relationships with clinical providers and communicate coding and documentation guidelines and requirements of the Risk Adjustment program to ensure correct coding, billing and documentation.

3.Analyzes data to prioritize provider educational reviews. Compiles data and present solutions regarding trends or patterns noticed in provider coding. Implements education, where necessary, and provides formal training to providers and staff regarding coding, billing and documentation standards.

4.Assists, as needed, with Concurrent coding to meet departmental goals/deadlines. Maintains a 96% quality audit accuracy rate.

5.Assists with research, analysis and response to inquiries regarding compliance, coding, and inappropriate coding.

6.Performs the minimum number of coding quality reviews consistent with established departmental goals. Maintains strictest confidentiality based on HIPAA privacy policy. Meets the performance requirements through provider and office staff training and performance improvement plans.

7.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.

8.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.


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.

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. Hold the Clinical Documentation Improvement Outpatient (CDIP) credential or similar CDI focused credential.

DATE APPROVED 10/06/2019

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Risk Adjustment Coder Educator

Banner Health