CLIN DOC SPEC-RISK ADJUSTMENT- FT (8 hour) Day

Stanford Health Care•Palo Alto, CA

6d•$65 - $86

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 programs at Stanford Health Care. The specialist works with clinical providers on documentation integrity strategies, opportunities, and clarification requests. The position performs prospective and concurrent Clinical Documentation Improvement workflows and retrospective auditing, reviews records for accurate HCC coding and diagnosis recapture opportunities, and verifies that submitted diagnoses meet M.E.A.T. criteria. It also collaborates across departments on coding updates and risk adjustment programs, tracks review results for education and training, supports coding and compliance updates and privacy policies, and maintains current knowledge of risk adjustment guidelines. The role requires a bachelor’s degree in nursing, medicine, health information management, or a related field, or an equivalent combination of education and experience. More than five years of healthcare experience is required, including 2–5 years in a risk adjustment program supporting and communicating with clinicians about prospective and concurrent activities, with demonstrated knowledge of regulatory billing and coding guidelines. One of the listed certifications is required. The position is full-time, day shift, with an 8-hour schedule. Generally, the base pay scale starts at $64.63–$85.65 per hour; the selected finalist’s salary depends on several factors and the stated scale is not a wage promise.

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 supporting and communicating with clinicians about prospective and concurrent risk adjustment activities.
Demonstrated knowledge of regulatory billing and coding guidelines.
One of the listed credentials: 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 functional responsibilities.
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 working relationships, build consensus, and establish collaborative relationships.
Ability to deliver oral presentations and prepare concise written reports for varied 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 about 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 diagnosis 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 implementation of emerging coding and compliance requirements and privacy policies.
Maintain current knowledge of risk adjustment coding guidelines through research, professional publications, professional networks, seminars, webinars, and medical organization meetings.
Perform other assigned duties and participate in organization projects.
Adhere to Stanford Health Care’s C-I-CARE standards and patient-experience principles.