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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

ConsultantConsultantFull TimeRemoteSeniorTeam 10,001Company Site

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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