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

LE0010 Stanford Health Care; Palo Alto (CA); On-site; USD 88,000 - 118,000; Full time

Job summary

Stanford Health Care is seeking a Clinical Documentation Specialist-Risk Adjustment to perform code audits and abstraction in line with state, federal, and internal policies. The role engages in CDI workflows and retrospective reviews to ensure accurate HCC coding and recapture opportunities.

You will collaborate with clinicians, analyze MEAT criteria, and contribute to training materials and education on risk adjustment, while staying current with coding guidelines and privacy policies.

Qualifications

• Bachelor’s degree in Nursing, Medicine, Health Information Management or related field or equivalent experience.
• Over 5 years healthcare experience, with 2–5 years in risk adjustment.
• Knowledge of regulatory billing and coding guidelines.

Responsibilities

• Perform prospective and concurrent CDI workflows and retrospective auditing.
• Review medical records to ensure accurate HCC coding and recapture opportunities.
• Verify MEAT criteria support for submitted diagnoses.
• Collaborate with departments to address coding updates and risk adjustment programs.
• Track and report review results to develop education materials for risk adjustment.

Skills

Risk adjustment

CPT/HCPCS/ICD-10 knowledge

Clinical documentation

Team collaboration

Communication with clinicians

Education

Bachelor's degree in Nursing or related field

Master’s degree preferred

Tools

Electronic health records

Job description

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 Improvement Practitioner or CRCR - Certified Revenue Cycle Representative or COC - Certified Outpatient Coder or CPC - Certified Professional Coder or CCS - Certified Coding Specialist or Health Care Quality (HACP, CPHQ, HCQM) certification or CCM - Certified Case Manager or These principles apply to ALL employees: SHC Commitment to Providing an Exceptional Patient & Family Experience Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery. You will do this by executing against our three experience pillars, from the patient and family’s perspective: Know Me: Anticipate my needs and status to deliver effective care Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer

Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale

Generally starting at $64.63 - $85.65 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage. At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow. As part of our spirit of discovery, we also leverage our deep relationships with luminary Silicon Valley companies to develop new ways to deliver preeminent patient care.

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