Clinical Quality Consultant NP

Elevance Health•Grand Prairie, MN

11d•$114,608 - $199,056•Remote

About The Position

This role is responsible for quality documentation, coding, and value capture. The primary duties include supplying clinical expertise to ensure full, accurate, and appropriate diagnosis, documentation, coding, and care through chart reviews. The role involves reviewing all provider visit medical encounters and applying the most appropriate diagnosis codes. Overall accountability for HCC/Risk Adjustment goals and workflows to support value capture initiatives and high-quality clinical documentation is key. Additionally, the role involves chart reviews for closing HEDIS care opportunities, acting as a liaison to the coding team, and participating in peer review of medical documentation. Reviews and corrects ICD-10 codes assigned in charts and provides feedback to providers for improved documentation.

Requirements

Requires an MS in Nursing and minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model; or any combination of education and experience, which would provide an equivalent background.
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.
Travels to worksite and other locations as necessary.

Nice To Haves

Prefer AAPC Certified Risk Adjustment Coder

Responsibilities

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.
Chart reviews for closing HEDIS care opportunities.
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.
Reviews and corrects any ICD-10 codes that have been assigned in charts.
Provide feedback to the provider for improved documentation to support specific codes.