CLIN DOC Spec-Risk Adjustment

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…