Clinical Quality Consultant NP
Core
Review provider visit medical encounters to ensure accurate diagnosis, documentation, and coding for HCC/Risk Adjustment and HEDIS goals.
Role type
Senior Clinical Quality Consultant (Nurse Practitioner)
Builds
High-quality clinical documentation and risk adjustment data for health plans
Domain
Healthcare administration / Risk Adjustment / HEDIS
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
HCC model application, CMS Risk Adjustment Model, ICD-10 coding, chart review, medical documentation analysis, HEDIS care opportunity identification, EMR navigation
Preferred skills
AAPC Certified Risk Adjustment Coder
Technologies
EMR systems
Responsibilities
Review all provider visit medical encounters and apply appropriate diagnosis codes, Review and correct assigned ICD-10 codes in charts, Provide feedback to providers for improved documentation, Participate in peer review of medical documentation, Liaise with coding team, Close HEDIS care opportunities
Seniority
Senior, hands-on IC
