Salaried Optum Health Coding Risk Adjustment Jobs in California

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.

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 and
• CRC - Certified Risk Adjustment Coder
• CCDS - Cert Clinical Document Spec preferred

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:

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 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 (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, 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, or 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.