CLIN DOC SPEC-RISK ADJUSTMENT- FT (8 hour) Day
About The Position
The Clinical Documentation Specialist-Risk Adjustment performs code audits and abstraction in accordance with state and federal regulations, internal policies, and procedures. The role supports quality assurance auditing and risk adjustment code abstraction for Stanford Health Care programs. It is based in Palo Alto, California, and is listed as a hybrid, full-time, day-shift position with an 8-hour schedule. The specialist works with clinical providers and other departments to support documentation integrity, accurate HCC coding, risk adjustment programs, and compliance. The role includes prospective and concurrent Clinical Documentation Improvement workflows and retrospective auditing, along with tracking and reporting review results for education and training. The position also requires keeping current with risk adjustment coding guidance and participating in assigned organizational projects.
Requirements
- Bachelor’s degree in Nursing, Medicine, Health Information Management, or a similarly related field, or an equivalent combination of education and experience.
- Over 5 years of healthcare experience, including 2–5 years in a risk adjustment program.
- Experience supporting and communicating with clinicians about prospective and concurrent risk adjustment activities.
- Demonstrated knowledge of regulatory billing and coding guidelines.
- One of the following certifications: CCDS, CDIP, CRCR, COC, CPC, CCS, a Health Care Quality certification (HACP, CPHQ, or HCQM), or CCM.
- Knowledge of local, state, and federal regulatory requirements related to areas of functional responsibility.
- Demonstrated knowledge of CPT, HCPCS, and ICD-10 codes and rules.
- Ability to analyze and develop solutions to complex problems and research complex coding and regulatory guidelines.
- Ability to work effectively as a team player and leader, apply judgment, and make informed decisions.
- Ability to foster effective working relationships, build consensus, and establish and maintain collaborative relationships.
- Ability to make oral presentations and prepare concise written reports for a variety of audiences.
- Ability to plan, organize, prioritize, work independently, and meet deadlines.
- Knowledge of computer systems and software used in the functional area.
- Ability to bring multidisciplinary teams together to seek consensus and address problems.
Nice To Haves
- Experience in academic health care, integrated delivery systems, or large physician-led organizations.
- Experience with accountable care organizations, risk-based contracts, care model redesign, and enterprise performance governance.
- Master’s degree in a work-related field or discipline from an accredited college or university.
- Registered Nurse preferred.
- Case management, utilization review, and/or direct provider interaction experience.
Responsibilities
- Maintain liaison with department or service line clinical providers on documentation integrity strategies, opportunities, and clarification requests.
- Perform prospective and concurrent Clinical Documentation Improvement workflows and retrospective auditing.
- Review medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses.
- Evaluate medical records to verify that M.E.A.T. criteria support submitted diagnosis codes.
- Inquire with clinicians about recommended HCC diagnoses for chart addenda.
- Collaborate with other departments on coding updates and support risk adjustment programs.
- Track and report review results for development of education and training materials on risk adjustment coding and documentation best practices.
- Assist with implementing emerging coding practices and compliance with laws and regulations, and implement privacy policies.
- Maintain current knowledge of risk adjustment coding guidelines through research, professional publications, professional networks, seminars, webinars, and medical organization meetings.
- Perform other duties and participate in organizational projects as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
