CLIN DOC SPEC-RISK ADJUSTMENT- FT (8 hour) Day
Core
Perform code audits, abstraction, and quality assurance auditing for risk adjustment programs to ensure accurate HCC coding and diagnosis verification.
Role type
Senior Clinical Documentation Specialist (Risk Adjustment)
Builds
Risk adjustment programs supporting regulatory billing and compliance
Domain
Healthcare / Medical Coding / Risk Adjustment
Required skills
HCC coding, ICD-10, CPT, HCPCS, medical record review, regulatory compliance, prospective/concurrent CDI workflows, retrospective auditing, clinician liaison, data reporting
Preferred skills
Academic health care experience, accountable care organizations, case management, utilization review, Master's degree, Registered Nurse, complex problem analysis
Technologies
Electronic Health Records (EHR), coding software, reporting tools
Responsibilities
Maintain liaison with clinical providers for documentation integrity; Perform prospective, concurrent, and retrospective CDI workflows; Review medical records for accurate HCC coding and M.E.A.T. criteria verification; Inquire with clinicians for recommended HCC diagnoses; Collaborate on coding updates and risk adjustment programs; Track and report review results for training materials; Maintain knowledge of coding guidelines through research and seminars.
Seniority
Senior, hands-on IC
