Risk Adjustment Clinical Documentation Specialist-1

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

2d•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 program of nursing.
5 years of adult acute or ambulatory care experience in med/surg or physician office setting.
Current state Registered Nurse license.

Nice To Haves

BSN preferred.
Certified Coder (COC or CPC) preferred.
1 year of Clinical Documentation Improvement (CDI) experience.
Certified Risk Adjustment Coder (CRC).

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.
Manage and adjust to changing work volumes and priorities.
Communicate with HIM and/or billing staff and resolve discrepancies.
Document activity and outcomes accurately, consistently, and in a timely manner.
Participate in data collection, analysis, and reporting for program management and performance improvement.