Elevance Health
Elevance Health is fueled by a purpose to strengthen the health of humanity by redefining health, reimagining the health system, and improving communities. Reco
Clinical Quality Consultant
Location
Ohio + 1 moreAll locations: Ohio, Tennessee
Posted
30 days ago
Salary
$120.6K - $150.8K / year
Seniority
Senior
Postgraduate Degree3 yrs expEnglish
Job Description
• 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
Job 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
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