Senior Risk Adjustment Coder (CPC, CRC, and CCDS required)
Stanford Medicine Partners
Newark, CA (Remote/CA Resident)
Stanford Medicine Partners (SMP) is looking for an amazing Senior Risk Adjustment Coder to join our rapidly growing team!
SMP prides itself in offering exceptional service and patient care. Stanford Medicine Partners with Stanford Health Care to provide individualized and convenient care with access to Stanford specialists and technology.
Join our team and start making a difference today!
A Brief Overview
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.
What you will do
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.
Qualifications
- Must be a California resident.
- High school diploma or GED equivalent.
- 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.
- Bachelor's Degree preferred.
- Understanding of the professional revenue cycle preferred.
Required Knowledge, Skills and Abilities
- 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.
Licenses and Certifications
- CPC - Certified Professional Coder and
- CRC - Certified Risk Adjustment Coder and
- CCDS - Cert Clinical Document Specialist