Position Summary TheMedical Coder/Audit Specialist position is an exempt salaried position thatensures that AAAI's coding, documentation, and billing practices are accurate,compliant, and aligned with payer regulations. This role reduces risk exposure,strengthens revenue capture, manages payer portals, and supports providersthrough education and proactive auditing. This position supports timelysubmission of insurance claims to a wide variety of payers and functions as anintermediary between healthcare providers, clients, patients and healthinsurance companies.
- Must be certified from an accredited organization such as AAPC (CPC) (CCS) is required in coding and / or billing.
Reports To: Medical PracticeAdministrator
Principal Duties andResponsibilities 1.Revenue Protection & Growth - Accurate Coding = Correct Reimbursement: Ensures all CPT/ICD-10 codes and HCPCS are properly supported, reducing underpayments.
- Audit-Driven Optimization: Identifies missed billable opportunities (e.g., modifiers, add-on codes).
- Payer Portal Management: Monitors real-time claim status, eligibility verification, and payer communications to reduce revenue leakage.
- ROI Impact: Every 1% improvement in coding accuracy equates to significant annual revenue recovery across 7 AAAI clinics.
2.Denial Prevention - Front-End Risk Mitigation: Reduces avoidable denials through pre-claim audits and provider training.
- Analyze Data: analyze patient records and documentation to extract relevant information for coding.
- Trend Analysis: Tracks payer denial patterns and provides feedback loops to billing and operations.
- Portal-Driven Resolution: Uses payer portals to identify denial root causes and expedite corrections/resubmissions.
- Result: Higher first-pass claim acceptance → faster cash flow → lower AR days.
3.Compliance & Risk Reduction - Regulatory Alignment: Keeps AAAI compliant with CMS and payer policies, including HIPAA, to maintain patient confidentiality and data security.
- Audit Preparedness: Reduces exposure to recoupments during external audits
- Documentation Support: Ensures providers' charts withstand legal and payer scrutiny.
- Portal Accuracy: Verifies payer policies and coding requirements directly within payer portals to avoid compliance risks.
- Stay Updated: keep abreast of changes in coding standards and regulations to ensure compliance and accuracy in coding practices.
4.Provider & Staff Support - Provides coding education to physicians, PAs, and clinical staff.
- Develop quick-reference tools to improve documentation accuracy.
- Acts as a resource for operational leaders on payer rules, portal updates, and coding changes.
- Other duties as assigned.
Required Knowledge,Skill and Abilities 1. Musthave experience with third party billing of physician services.
2. Strongorganizational skills with ability to manage multiple workstreams.
3. Excellentcommunication and interpersonal skills.
4. Excellentwritten and verbal communication skills.
5. Knowledgeof regulatory requirements and healthcare laws.
6. Abilityto analyze data and make informed decisions.
7. Strongorganizational and time management skills.
8. Abilityto work well under pressure and in a fast-paced environment.
9. Ability to engage confidently withphysicians, staff, and community partners.
10. Proficiency in MicrosoftOffice Suite and EMR/credentialing systems.
11. Ability to understandand interpret policies and regulations.
12. Ability to read andinterpret medical charts.
13. Ability to examinedocuments for accuracy and completeness.
14. Ability to understandand interpret EOB's/ERA's
15. Strong understanding ofmedical terminology.
Education - Must have a high school diploma or equivalency.
- Must be certified from an accredited organization such as AAPC (CPC) (CCS) is required in coding and / or billing.
- An associate or bachelor's degree in health information management is preferred.
Experience - Minimum of four years of directly related experience.
- Minimum of two years' billing and/or collections experience in a health care organization. Two or more years preferred.
Other Requirements SuccessMetrics - ≥ 95% coding accuracy rate.
- Year-over-year reduction in avoidable denials.
- Measurable increase in reimbursement capture (CPT utilization, correct modifier application, portal-driven optimization).
- Full compliance during external audits.
Working Conditions OSHACategory 3: Involves no regular exposure to blood, body fluids, or tissues, andtasks that involve exposure to blood, body fluids, or tissues are not acondition of employment. Position is ina well-lighted office environment. Occasional evening and weekend work. Requires sitting and standing associated with a normal officeenvironment. Manual dexterity using calculator. Standard office equipment will be operated including computers, faxmachines, copiers, printers, telephones, calculators, etc.
Az Asthma & Allergy Institute is an EEO Employer - M/F/Disability/Protected Veteran Status