Risk Adjustment Clinical Documentation Specialist

St. Luke's University Health Network•Allentown, PA

3d•Onsite

About The Position

The Risk Adjustment Clinical Documentation Specialist facilitates accurate, complete, consistent, and timely documentation for severity of illness and quality in medical records completed in the physician office setting. This involves extensive record review, interaction with physicians, advanced practitioners, health information management professionals, nursing staff, and other physician office staff.

Requirements

Graduation from a nursing program.
Certified Professional Coder (CPC) and a Certified Risk Coder (CRC) required.
5 years of adult acute or ambulatory care experience in med/surg or physician office setting with both CPC and CRC coding credentials required.
One year of Clinical Documentation Improvement (CDI) experience.

Nice To Haves

BSN preferred.
Current state Registered Nursing License preferred.

Responsibilities

Review medical record(s) for completeness, accuracy, consistency, and clinical evidence for severity of illness (appropriate capture of true disease burden and quality using official Risk Adjustment and relevant official documentation/coding guidelines.
Accurate, comprehensive, and timely medical record review.
Consistent and effective use of Compliant Documentation Management Program (CDMP) Risk Adjustment strategies.
Recognize opportunities for documentation improvement.
Formulate clinically credible documentation clarifications.
Request documentation clarifications as appropriate for severity of illness.
Effective and appropriate communication with Providers.
Timely follow up on all cases and resolution of those with clinical documentation clarifications.
Provide routine formal and informal (just-in-time) Risk Adjustment and documentation improvement education to providers/staff.
Participate in Risk Adjustment steering committee meetings.