Clinical Quality Consultant

Role Overview

• quality documentation, coding and value capture
• focus on chart reviews by supplying clinical expertise to ensure full accurate and appropriate diagnosis, documentation, coding and care
• review all provider visit medical encounters and apply most appropriate diagnosis codes
• overall accountability for the HCC/Risk Adjustment of goals and workflows to support value capture initiatives and high-quality clinical documentation
• liaison to coding team
• chart reviews for closing HEDIS care opportunities to ensure practice and health plan success
• participate in peer review of medical documentation for completed visit notes and patient profile information in EMR
• review and correct any ICD-10 codes that have been assigned in charts
• provide feedback to the provider for improved documentation to support specific codes

Requirements

• Requires an MS in Nursing
• minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model
• Requires a current, active, valid and unrestricted RN license and NP license in applicable state(s)
• Multi-state licensure is required if this individual is providing services in multiple states
• satisfactory completion of a Tuberculosis test is a requirement for this position
• Prefer AAPC Certified Risk Adjustment Coder

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution