Risk-Adjustment Clinical Documentation Expert

Cedars-Sinai; Los Angeles (CA); On-site; USD 85,000 - 110,000; Full time

Job summary

Cedars-Sinai is seeking a Clinical Documentation Specialist to perform chart reviews and pre-charting for risk-adjustable patient populations. The role requires applying clinical knowledge to identify relevant diagnoses for PCP consideration at the time of the patient visit.

The position leads or provides education to clinical care and administrative teams on documentation standards essential for risk adjustment and CMS/regulatory compliance, and helps develop training materials as needed.

Qualifications

• High School Diploma or GED required.
• Bachelor's Degree in Nursing or Health Information Management preferred.

Responsibilities

• Perform clinical chart reviews and pre-charting for risk-adjustable patient populations.
• Correlate diagnoses for PCP consideration at face-to-face visits using clinical knowledge.
• Track and verify findings and outcomes of reviews.

Skills

Critical thinking

Presentations

Training & education delivery

Education

High School Diploma/GED

Bachelor's Degree in Nursing or Health Information Management

Tools

Microsoft Office

Excel

PowerPoint

Risk adjustment analytics platforms

Job description

Job Description

This position is Hyrbid but will require travel throughout the Greater Los Angeles area on a regular basis.

The Clinical Documentation Specialist works independently and is responsible for performing clinical chart
reviews and pre-charting on risk adjustable patient populations. The Clinical Documentation Specialist
exercises critical thinking by applying clinical knowledge to correlate relevant diagnoses for the primary
care physician (PCP) to consider at the time of the face to face visit. The Clinical Documentation Specialist
will also be responsible for tracking and verifying all their findings.

Leads or provides education/training to clinical care and administrative support team members regarding
the clinical documentation requirements essential for risk adjustable diagnoses and their impact on
reimbursement and regulatory requirements set forth by CMS and other regulatory entities. Assists in
developing educational materials as needed.

Qualifications

Education

• High School Diploma/GED - minimum
• Bachelor's Degree Bachelor's Degree in Nursing or Health Information Management. - preferred

Experience

• 3 years Medicare risk adjustment coding & documentation required
• 2 years Experience providing training information to clinical and administrative
  staff preferred
• 3 years Experience using software such as Microsoft Office including Excel and
  PowerPoint to develop presentations preferred
• 1 year Exposure to risk adjustment analytics platform(s) to gain insights into
  risk adjustment performance and opportunities required

Licenses and Certifications

• Valid Clinical CA license preferred (PA, NP, LVN or RN)
• Registered Health Information Administrator preferred
• AHIMA or AAPC coding credential and/or registration (One or more of the following: CDIP, CDEO, CCS, CPC, CRC) required