Sr Risk Adjustment Coder

Overview

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Day - 08 Hour (United States of America)

This is a Stanford Health Care - University Healthcare Alliance job.

The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment.

Stanford Health Care - University Healthcare Alliance

• Risk Adjustment Review
• May perform 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
• Compliance Reporting
• 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 laws and regulations and assist with 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
• All other duties as assigned including department-specific functions and responsibilities:
  Performs other duties as assigned and participates in organization projects as assigned
• Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies

• High school diploma or GED equivalent
• Bachelor's Degree preferred

• 5+ years of work experience in a risk adjustment program supporting and communicating with clinicians with prospective and/or concurrent role within a healthcare setting with demonstrated knowledge and of regulatory billing and coding guidelines
• Understanding of the professional revenue cycle preferred

• 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
• 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 establish and maintain collaborative effective working relationships
• Ability to bring together multi-disciplinary teams to seek consensus and value problem

• CPC - Certified Professional Coder
• CRC - Certified Risk Adjustment Coder
• CCDS - Cert Clinical Document Spec

Physical Demands

• Constant Sitting
• Frequent Walking
• Occasional Standing
• Occasional Bending
• Occasional Squatting
• Occasional Climbing
• Occasional Kneeling
• Seldom Crawling
• Constant Hand Use
• Constant Repetitive Motion Hand Use
• Frequent Grasping
• Occasional Fine Manipulation
• Frequent Pushing and Pulling
• Occasional Reaching (above shoulder level)
• Frequent Twisting and Turning (Neck and Waist)
• Constant Vision (Color, Peripheral, Distance, Focus)

Lifting

• Frequent lifting of 0 - 10 lbs
• Occasional lifting of 11 - 20 lbs
• Seldom lifting of 21 - 30 lbs
• Seldom lifting of 31 - 40 lbs
• Seldom lifting of 40+ lbs

Carrying

• Frequent lifting of 0 - 10 lbs
• Occasional lifting of 11 - 20 lbs
• Seldom lifting of 21 - 30 lbs
• Seldom lifting of 31 - 40 lbs
• Seldom lifting of 40+ lbs

Working Environment

• Occasional Driving cars, trucks, forklifts and other equipment. May be required to drive personal vehicle to sites
• Constant Working around equipment and machinery. Office equipment (computers, phones, fax, copy machines, printers, 10-key, etc.)
• Seldom Walking on uneven ground
• Seldom Exposure to excessive noise
• Seldom Exposure to extremes in temperature, humidity or wetness
• Seldom Exposure to dust, gas, fumes or chemicals
• Seldom Working at heights
• Seldom Operation of foot controls or repetitive foot movement
• Seldom Use of special visual or auditory protective…