Clinical Quality Consultant
Elevance Health
full-time
Posted on:
Location Type: Remote
Location: Ohio • Tennessee • United States
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Salary
💰 $120,640 - $150,800 per year
About the role
- quality documentation, coding and value capture
- focus on chart reviews by supplying clinical expertise to ensure full accurate and appropriate diagnosis, documentation, coding and care
- review all provider visit medical encounters and apply most appropriate diagnosis codes
- overall accountability for the HCC/Risk Adjustment of goals and workflows to support value capture initiatives and high-quality clinical documentation
- liaison to coding team
- chart reviews for closing HEDIS care opportunities to ensure practice and health plan success
- participate in peer review of medical documentation for completed visit notes and patient profile information in EMR
- review and correct any ICD-10 codes that have been assigned in charts
- provide feedback to the provider for improved documentation to support specific codes
Requirements
- Requires an MS in Nursing
- minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model
- Requires a current, active, valid and unrestricted RN license and NP license in applicable state(s)
- Multi-state licensure is required if this individual is providing services in multiple states
- satisfactory completion of a Tuberculosis test is a requirement for this position
- Prefer AAPC Certified Risk Adjustment Coder
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-10 codingclinical documentationHCC/Risk Adjustmentchart reviewsdiagnosis codingvalue capturepeer reviewmedical documentationcoding expertiseprovider feedback
Soft Skills
communicationcollaborationattention to detailanalytical thinkingproblem-solving
Certifications
RN licenseNP licenseAAPC Certified Risk Adjustment Coder