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 data for health plans
Domain
Healthcare administration / Risk Adjustment
Required skills
Clinical expertise in diagnosis and documentation, Medicare HCC model knowledge, CMS Risk Adjustment Model experience, ICD-10 coding proficiency, EMR navigation, peer review of medical notes, provider feedback delivery
Preferred skills
AAPC Certified Risk Adjustment Coder
Technologies
EMR systems, ICD-10 coding standards
Responsibilities
Review all provider visit medical encounters and apply appropriate diagnosis codes, Ensure full accurate and appropriate diagnosis, documentation, and coding for value capture, Liaise with coding team to close HEDIS care opportunities, Participate in peer review of medical documentation for completed visit notes, Review and correct assigned ICD-10 codes in charts, Provide feedback to providers for improved documentation
