Clinical Documentation Specialist

5 days ago


San Francisco, United States Wellvana Full time
Wellvana Clinical Documentation Specialist - Risk Adjustment Expert

 

About Wellvana

At Wellvana, we're revolutionizing the healthcare system by aligning incentives with quality care. Our innovative approach ties patient outcomes directly to shared savings for providers, health systems, and payors.

We've been recognized as one of the fastest-growing healthcare companies in America, named a 2024 'Best in Business' and 2023 'Best Place to Work' by Nashville Business Journal. Our team is dedicated to delivering life-changing healthcare through elevated value-based care programs.

Job Description

The Clinical Documentation Specialist - Risk Adjustment Expert will partner with Wellvana-affiliated practices and health systems to ensure accurate risk adjustment coding and regulatory compliance. This role requires strong knowledge of industry rules and regulations, particularly risk adjustment coding and HCC Risk Adjustment Model Categorical Hierarchy.

  • Review clinical data and patient documentation to confirm diagnoses prior to physician visits
  • Identify coding trends and documentation patterns through data analysis and audits
  • Communicate effectively with physicians and practice leaders on risk adjustment coding and HCC hierarchy
  • Maintain a comprehensive schedule and visit log, documenting all education materials and discussions
  • Build positive relationships with assigned physicians and serve as a key point of contact for questions or concerns

This role demands attention to detail, analytical skills, and effective communication. The ideal candidate will have a thorough understanding of risk adjustment coding, HCC Risk Adjustment Model Categorical Hierarchy, and ability to identify potential areas of fraud and abuse.

Requirements

For this role, we're seeking a Registered Nurse with:

  • A Bachelor's degree (preferred)
  • Unrestricted license to practice in Texas
  • CRC & CPC certifications required, CPMA preferred
  • 5+ years of experience in risk adjustment coding and documentation improvement queries
  • Minimum 3+ years of clinical practice experience

Competitive salary: $120,000 - $150,000 per annum, dependent on location and experience.



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