Clinical Reviewer, Diagnosis Accuracy

HealthPartners•Bloomington, MN

1d•Onsite

About The Position

Highly skilled clinician to support the ongoing work of the Diagnosis Accuracy Program. The individual will review patient records to assess diagnosis code specificity, identify documentation and coding opportunities based on supporting clinical evidence, and validate suspect conditions.

Requirements

Advanced Practice Clinicians either Master of Science in Nursing degree (Nurse Practitioner), Physician Assistant (PA), or Registered Nurse (RN) with clinical coding experience
Minimum two years clinical experience
Maintain a current, active, unrestricted state licensed/certification as a Nurse Practitioner (NP), Physician Assistant (PA), or Registered Nurse
Strong clinical background with in-depth knowledge of medical terminology, pathophysiology, pharmacology, and disease interactions, supported by sound clinical judgment and ability to interpret complex medical information
Strong and demonstrated PC skills are required along with an ability to learn new systems
Experience with electronic medical record and billing modules (e.g. Epic)
Strong verbal, and written communication, skills
Ability to work with others and develop consensus among differing parties
Knowledge of ICD-10 diagnosis coding, clinical documentation requirements, and clinical documentation improvement concepts
Ability to self-direct work, detail orientated and organized
Ability to manage and impart confidential information

Nice To Haves

Certified Professional Coder (CPC) or Certified Coding Specialist (CCS-P) Certification
AHIMA accredited Registered Health Information (RHIT), or Registered Health Information Administer (RHIA)
Certified Documentation Expert – Outpatient (CDEO)
Certified Risk Coder (CRC) certification
Certified Clinical Documentation Specialist – Outpatient (CCDS-O)
Knowledge of multiple payment and risk adjustment methodologies used by government and commercial payers
Ability to work collaboratively with others
Ability to work in an ever-changing environment with differing perspectives and ability to resolve situations effectively

Responsibilities

Review patient records to assess diagnosis code specificity
Identify documentation and coding opportunities based on supporting clinical evidence
Validate suspect conditions