Nurse Practitioner Clinical Quality Consultant
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 workflows
Domain
Healthcare administration / Risk Adjustment / HEDIS
Required skills
Clinical expertise in diagnosis and documentation, Medicare HCC model application, CMS Risk Adjustment Model application, ICD-10 coding, EMR review, peer review of medical documentation, provider feedback
Preferred skills
AAPC Certified Risk Adjustment Coder
Technologies
EMR, ICD-10
Responsibilities
Review all provider visit medical encounters and apply appropriate diagnosis codes, Ensure full accurate and appropriate diagnosis, documentation, and coding, Liaise with coding team, Participate in peer review of medical documentation, Provide feedback to providers for improved documentation, Review and correct assigned ICD-10 codes
