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Day - 08 Hour (United States of America)
This is a Stanford Health Care - University Healthcare Alliance job.
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.
Locations Stanford Health Care - University Healthcare Alliance
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
Education Qualifications High school diploma or GED equivalent
Bachelor's Degree preferred
Experience Qualifications 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
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
CRC - Certified Risk Adjustment Coder
CCDS - Cert Clinical Document Spec
Physical Demands and Work Conditions 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 equipment
Seldom Use of respirator
Seldom Working with biohazards such as blood borne pathogens, hospital waste, etc.
Seldom Other (please list each item under Comments):.
Blood Borne Pathogens Category III - Tasks that involve NO exposure to blood, body fluids or tissues, and Category I tasks that are not a condition of employment
Travel Requirements 10% travel
Principles that Apply to ALL Employees 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 strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including employment. 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, 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 $44.13 - $57.36 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.
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