Clinical Quality Consultant, NP

Role Overview

• Focus on chart reviews by supplying clinical expertise to ensure full accurate and appropriate diagnosis, documentation, coding and care
• Review provider visit medical encounters and apply appropriate diagnosis codes
• Overall accountability for HCC/Risk Adjustment goals and workflows to support value capture initiatives and high-quality clinical documentation
• Chart reviews for closing HEDIS care opportunities
• Liaison to coding team
• Participate in peer review of medical documentation for completed visit notes and patient profile information in EMR
• Review and correct ICD-10 codes assigned in charts
• Provide feedback to providers 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
• Current, active, valid and unrestricted RN license and NP license in applicable state(s)
• Multi-state licensure is required if providing services in multiple states
• Prefer AAPC Certified Risk Adjustment Coder

Benefits

• Health insurance
• 401(k) matching
• Paid time off
• Flexible work arrangements
• Professional development opportunities
• Equity stock purchase
• Incentive and recognition programs