Stanford Health Care

Medical writer

• Reviews clinical documentation to facilitate the accurate representation of the severity of illness, expected risk of mortality, and complexity of care by improving the quality of the physician’s clinical documentation
• Initiates medical record review within 24 to 48 hours of admission
• Monitors, systematically, the targeted medical records within at least 48 hours unless otherwise indicated to determine compliance to established documentation standards
• Conducts follow-up reviews to ensure points of clarification have been addressed/documented in the medical record

Clinical Documentation Integrity Specialist I

Therapist

• Participates in clinical teaching, including the clinical instruction of physical therapy interns/students, residents, and other staff.
• Prepares and presents an in-service (at least one annually).
• Provides input regarding the educational needs of the staff and serves as a resource in meeting those needs.
• With the support of the manager, may initiate clinical research within area of clinical expertise.
• Provides mentoring to others when appropriate and serves as a role model/resource/teacher/mentor to less experienced physical therapists.
• Leads patient care conferences, communicating with and teaching other care providers.
• Identifies departmental performance improvement issues and participates in performance improvement activities, e.g. chart reviews, revision of documentation forms, workflow studies, etc.
• Contributes to the development of departmental policies and procedures.
• Identifies needs for equipment repair or upgrade to maintain quality of care; makes recommendations for selection and purchase of specific equipment and supplies.

Physical Therapist – Acute Care

Medical Billing and Coding

• Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, CPT codes and modifiers as applicable, leading to the assignment of the correct Ambulatory Payment Classification (APC)
• Validates outpatient accounts for medical necessity based on local coverage determination policies (LCDs) or national coverage determinations (NCDs)
• Codes procedures as appropriate and identifies the principal procedure consistent with established coding guidelines
• Collaborates with Clinical Documentation Specialists and members of the medical staff to ensure completeness of documentation

Outpatient Coding Specialist II

Manager

• Manages assigned staff and functions by assigning work and developing work procedures
• Performs management functions by interviewing and hiring staff members
• Collaborates with the Director of Advanced Practice to create, support, or lead initiatives

Advanced Practice Provider Manager – Pre-Anesthesia

Data Analyst

• Provides the full range of distributive, clinical, consultative, research, investigational, and/or administrative pharmaceutical services.
• Select, compound, manufacture, purchase, dispense, and/or preserve drugs, medicines, and other therapeutic agents.
• Serves as a member and consultant on treatment or diagnostic teams.
• Disseminates drug information to members of the hospital staff and interested community groups.
• May participate in hospital research projects or perform pharmaceutical research.

Clinical Pharmacist – Data Analytics

Human Resources

• Provides hands-on care to patients in an evidence-based manner
• Performs all steps of the nursing process including assessment, planning, implementation, and evaluation of care
• Teaches patients and families the knowledge needed to manage their care
• Monitors quality of nursing care provided
• Collaborates with healthcare team to develop individualized care plans

Clinical Nurse, Outpatient – Cancer Care Service – Oncology

Project Manager

• Plans, coordinates, and participates in the implementation of activities including seminars, conferences, workshops, and other related programs.
• Develops and coordinates new ideas and concepts for program themes.
• Coordinates all program logistics, materials, and resources.
• Provides administrative assistance to management staff within assigned areas to support the accomplishment of program objectives.
• Monitors and evaluates program effectiveness, investigate trends, and recommend and implement modifications to improve program effectiveness.

Program/Project Coordinator – Cardiac/Cath Lab

• Provides hands-on care to patients in psychiatry oncology
• Assesses patients, interprets data, plans, implements, and evaluates care
• Coordinates care with other providers and teaches patients and families
• Establishes therapeutic relationships and mobilizes patients' strengths for recovery
• Monitors the quality of nursing care provided

Clinical Nurse Outpatient, Psychiatry Oncology

• Requires review of medical record documentation to accurately assign ICD-10-CM/PCS codes
• Reviews, abstracts and assigns accurate and ethical ICD-10-CM/PCS codes to inpatient services
• Ensures compliance with third party, State and Federal regulations
• Completes volume of work from work queues per departmental productivity standards
• Collaborates with Clinical Documentation Specialists and medical staff to ensure completeness of documentation
• Maintains competency and accuracy while utilizing coding and abstracting systems

Inpatient Coding Specialist II

• Provides hands-on care to patients
• Collaborates with the care team to develop individualized plans
• Establishes therapeutic relationships with patients and families
• Monitors quality of nursing care provided

Clinical Nurse, RN – Oncology/Radiation Therapy

Program Manager

• Provides consultation, analysis, interpretation, and training on labor agreements
• Leads efforts to conduct highly complex analyses across Labor Relations
• Formulates strategies for process improvement, education, and enforcement of labor relations issues
• Prepares correspondence and reports, attends high level stakeholder meetings
• Builds relationships with employee representatives and supports union contract negotiations

Employee Labor Relations Program Manager

• Provides routine care and management of patients with acute and chronic complaints
• Collaborates with supervising physician and implements standardized procedures
• Evaluates and treats patients according to written standardized procedures
• Obtains complete histories and performs pertinent physical exams
• Performs or requests and evaluates diagnostic studies as needed
• Administers, orders, furnishes and prescribes medications

APP II – NP/PA, Regional Anesthesia

• Reviews medical record documentation and accurately assigns appropriate ICD-10-CM diagnoses, CPT codes and modifiers
• Validate and process any medical necessity edits
• Communicates effectively with provider teams across the organization
• Follows established coding conventions and guidelines
• Responsible for monitoring Discharged Not Billed accounts

Single Path Coding Specialist II

• Establish Therapeutic Relationships with patients and families.
• Obtain accurate assessment data and interpret as normal vs abnormal.
• Collaborate with health care team to develop individualized plan of care.
• Evaluate patient learning needs and provide necessary education.

Clinical Nurse, Oncology Clinic

Financial Planning and Analysis

• Completes insurance verification, eligibility and benefit determination process utilizing integrated electronic eligibility system, payer websites, and phone for all insurance plans within the scope of the patient financial clearance department and assigned service line.
• Interprets and documents the appropriate co-pay, deductible, share of cost, co-insurance, maximum benefit levels and/or available days.
• Contacts patient as appropriate to obtain correct and updated information when necessary.
• Completes Medicare Secondary Questionnaire as appropriate.
• Applies authorization rules and requirements for all payors within the assigned work queues.
• Develops a strong working knowledge of the procedures and diagnosis used in the assigned service-lines to ensure authorizations are properly completed for the scope of services that will be rendered to the patient.
• Assesses the data required for authorization and securing sponsorship.
• Communicates with respective clinics and referring providers to secure appropriate information to complete an authorization.
• Follows up on pending authorization and referral requests to ensure timely completion and secured sponsorship for cases in the assigned work queue.
• Arranges escalation process for clinics and clinicians to complete peer-to-peer appeal reviews with payor utilization management when needed.
• Prioritizes work assigned to them to ensure that financial risk is minimized, and timely completion of authorizations is optimized, while meeting daily productivity measure goals.
• Identifies risk associated with coverage and benefit issues related to the services that are being requested for authorization and escalates these issues to appropriate experts to address.
• Identifies risk associated with securing financial clearance prior to service date and escalates to clinic and other resources to find an appropriate course of action (e.g. reschedule, cancel, sign PAFR).
• Understands the role of financial counseling in securing clearance for cases that do not have authorization secured timely.
• Properly refers these cases as appropriate.
• Notifies the department manager with issues, instances of errors, or obstacles to successful completion of work.
• Applies strong writing skills to account documentation, email communication and internal notes/memos.
• Manages outbound and inbound phone calls.
• Responds promptly to customer inquiries.
• Assists team coordinator and department manager with special projects as needed.
• Serves as a resource for other payor authorization teams.
• Performs other duties and responsibilities as assigned by the Department.