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Day - 08 Hour (United States of America)
This is a Stanford Health Care job.
A Brief Overview
The Clinical Documentation Specialist-Risk Adjustment will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Clinical Documentation Specialist-Risk Adjustment will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs.
Locations
Stanford Health Care
What you will do Maintains liaison with department or service line clinical providers in documentation Integrity strategies, opportunities and specific clarification requests.
Performs prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing
Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses.
Evaluating medical records to verify that M.E.A.T. criteria support the submitted diagnosis codes.
Inquire with clinicians the recommended HCC diagnosis for chart addendum.
Collaborating with other departments to address coding updates and support risk adjustment programs.
Tracking and reporting review results that will be used to develop education and training materials on risk adjustment coding and/or documentation best practices.
Assist with the implementation of emerging coding and compliance with laws and regulations and implementing privacy policies.
Maintain current knowledge of risk adjustment coding guidelines by conducting research, reading professional publications, and maintaining professional networks. Attending coding seminar, webinars and medical organization meetings.
Performs other duties as assigned and participates in organization projects as assigned.
Education Qualifications Bachelor’s degree in Nursing, Medicine, Health Information Management or similarly related field of study or equivalent combination of education and experience.
Experience Qualifications Over 5 years of healthcare experience, including 2–5 years in a risk adjustment program, providing support to and communicating with clinicians about prospective and concurrent risk adjustment activities, with demonstrated knowledge of regulatory billing and coding guidelines.
Preferred Knowledge, Skills and Abilities 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/discipline from an accredited college or university.
Preferred Registered Nurse.
Case management, utilization review and/or direct provider interaction experience, preferred.
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.
Ability to perform research regarding complex coding and regulatory guidelines.
Ability to work effectively both as a team player and leader.
Ability to apply judgment and make informed decisions.
Ability to foster effective working relationships and build consensus.
Ability to make effective oral presentations and prepare concise written reports to a variety of audiences.
Ability to plan, organize, prioritize, work independently and meet deadlines.
Knowledge of computer systems and software used in functional area.
Ability to establish and maintain effective collaborative working relationships.
Ability to bring together multi-disciplinary teams to seek consensus and value problems.
Licenses and Certifications CCDS - Cert Clinical Document Spec or
CDIP – Clinical Documentation…