Clinical Quality Consultant
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Nashville • Ohio • Tennessee • United States
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Salary
💰 $120,640 - $150,800 per year
About the role
- Responsible for quality documentation, coding and value capture
- Supply 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
- Accountability for the HCC/Risk Adjustment of goals and workflows to support value capture initiatives
- Liaison to coding team
- Chart reviews for closing HEDIS care opportunities
- Participate in peer review of medical documentation for completed visit notes and patient profile information in EMR
- Review and correct any ICD-10 codes assigned in charts
- Provide feedback to the provider for improved documentation
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
- Current, active, valid and unrestricted RN license and NP license in applicable state(s)
- Multi-state licensure if 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
- paid holidays
- Paid Time Off
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-10 codingmedical documentationHCC/Risk Adjustmentvalue capturechart reviewspeer reviewdiagnosis codingclinical expertisecare opportunitiesdocumentation improvement
Soft Skills
accountabilitycommunicationcollaborationfeedback provisionattention to detail
Certifications
RN licenseNP licenseAAPC Certified Risk Adjustment Coder