Quality Reviewer, Diagnosis Accuracy

HealthPartners•Bloomington, MN

About The Position

Park Nicollet is looking to hire a Diagnosis Accuracy Quality Reviewer to join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day. Position Summary: The Diagnosis Accuracy Quality Reviewer (DA QR) is responsible for evaluating the accuracy, completeness, and clinical validity of diagnosis documentation within ambulatory care settings. This role conducts comprehensive chart audits, assesses documentation and coding practices, and ensures alignment with organizational standards, regulatory requirements, and risk‑adjustment methodologies. The DA QR provides structured, data‑driven feedback to clinicians and internal clinical review teams, supporting continuous improvement in documentation quality, problem list management, and diagnostic accuracy. Working collaboratively with clinical, operational, and coding stakeholders, the DA QR contributes to improved quality outcomes, compliant coding practices, and enhanced organizational performance through precise and reliable clinical documentation.

Requirements

Advanced Practice Clinician either Master of Science in Nursing degree (Nurse Practitioner), Physician Assistant (PA), or master’s prepared Registered Nurse (RN) with clinical coding experience
Minimum two years clinical experience
Minimum one-year clinical documentation, chart review, and ICD-10 diagnosis coding experience
Maintain a current, active, unrestricted state license/certification as a Nurse Practitioner, Physician Assistant, 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 along with an ability to learn new systems
Experience with electronic medical record (EMR) and billing modules (e.g., Epic)
Strong verbal and written communication skills
Ability to work collaboratively with others (e.g., clinicians, DA Operations, DA Clinical Team, coding professionals, clinical leaders)
Ability to work with differing perspectives and resolve situations effectively
Knowledge of clinical documentation improvement concepts
Ability to self-direct work, detail orientated, and organized
Demonstrates critical thinking skills
Ability to manage and impart confidential information

Nice To Haves

Clinical experience in ambulatory setting (e.g., primary care, oncology, pulmonary, urology)
Ambulatory clinical documentation, chart review, and ICD-10 diagnosis coding experience
Certified Professional Coder (CPC), Certified Coding Specialist (CCS-P), AHIMA accredited Registered Health Information (RHIT), Registered Health Information Administer (RHIA), Certified Documentation Expert – Outpatient (CDEO), Clinical Documentation Integrity Practitioner (CDIP), or Certified Clinical Documentation Specialist – Outpatient (CCDS-O)
Certified Risk Coder (CRC)
Knowledge of multiple payment and risk adjustment methodologies used by government and commercial payers
Strong understanding of audit concepts and principles
Ability to work in an ever-changing environment
Exceptional communication skills, with the ability to deliver succinct, clear, and professional written and verbal feedback
Ability to synthesize multiple clinical and workflow inputs and summarize findings concisely
Exceptional attention to detail, ensuring accuracy in documentation review, coding validation, and reporting
In-depth understanding of clinical workflows, EMR systems, and supporting technologies

Responsibilities

Evaluating the accuracy, completeness, and clinical validity of diagnosis documentation within ambulatory care settings.
Conducting comprehensive chart audits.
Assessing documentation and coding practices.
Ensuring alignment with organizational standards, regulatory requirements, and risk‑adjustment methodologies.
Providing structured, data‑driven feedback to clinicians and internal clinical review teams.
Supporting continuous improvement in documentation quality, problem list management, and diagnostic accuracy.
Working collaboratively with clinical, operational, and coding stakeholders.
Contributing to improved quality outcomes, compliant coding practices, and enhanced organizational performance through precise and reliable clinical documentation.