JOB DETAILS

• 60% Travel, 40% Work from Home
• Must be a Nurse Practitioner or Physician Assistant
• Full Time Permanent Position
• Growing Healthcare Company specializing in Nephrology
• Must have Risk Adjustment Experience
• Competitive Salary
• Excellent Benefits

JOB SUMMARY

As a Clinical Quality Documentation Reviewer, you will partner with physician offices, vendors and APP's within our established partnerships to assess the health information that includes improving clinical documentation, quality measures, and regulatory guidelines. 

As a Clinical Quality Documentation Reviewer, you will work in collaboration with Medical Coder as appropriate. You serve as a subject matter expert in clinical documentation, quality measures, and regulatory guidelines. 

RESPONSIBILITIES

• Work collaboratively with physicians, Advanced Practice Nurse Practitioners, other healthcare professionals and coding staff to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes, and quality is captured for the level of service rendered to all patients.
• Audit clinical documentation and coded data to validate documentation supports diagnoses, procedures, and treatment and identifies deficiencies of evidence-based practice. 
• Research, analyze, recommend, and facilitate plan of action to correct discrepancies and prevent future documentation discrepancies. 
• Provide feedback to providers to improve clinical documentation and facilitate ongoing documentation improvement to meet all requirements of the medical record. 
• Serve as a resource for documentation improvement including the ability to communicate and educate advanced practice clinicians and physicians
• Apply critical thinking and decision-making skills to determine if the medical record documentation supports the need for service while maintaining production goals and quality standards. 
• Assist management with training new Quality Documentation Reviewers to include daily monitoring, mentoring, feedback, and education. 
• Attend training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations. 
• Actively demonstrate the organization’s mission and core values and conducts oneself at all times in a manner consistent with these values. 
• Know and adhere to all laws and regulations pertaining to patient health, safety, and medical information. 

REQUIREMENTS

• Current and unrestricted Nurse Practitioner (NP) or Physician Assistant (PA-C) State License, including board certification, or the ability to become board certified within 2 years. 
• Completed an accredited program for Nurse Practitioner or Physician Assistant 
• CDEO or CDIP certification preferred
• CMS HCC Risk Adjustment experience (Mandatory) 
• 1+ years of auditing experience.
• 3+ years of clinical practice in a hospital, home care, or nursing home setting.
• Demonstrated experience in reviewing clinical documentation, chart audits. 
• Demonstrate an understanding of current Quality Measure Initiatives including Value Based Care. 
• Demonstrate knowledge of pathophysiology, disease management, and coding guidelines.
• Working knowledge of HIPAA Privacy and Security Rules.
• Ability to accept that things change quickly and are willing to pivot quickly on priorities. 
• Experience with EMR systems such as EPIC, Meditech, Cerner, Allscripts, Acumen. 
• Demonstrated proficiency in computer skills, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, Microsoft Teams. 
• Strong people skills and ability to build supportive relationships with providers. 
• Outstanding organizational skills and an ability to operate efficiently and independently. 
• A sound knowledge of medical coding guidelines and regulations, including compliance and reimbursement. This allows for a clear understanding of the impact of coding on payment models. 
• A thorough understanding of anatomy, pathophysiology, and medical terminology necessary to correctly code using CPT®, ICD-10-CM, and HCPCS Level II coding systems.

COMPENSATION & BENEFITS

• Competitive base pay with bonuses 
• Credit Card for Travel Expenses
• Paid time off starting at 4 weeks for full time employees 
• 11 paid holidays per year
• Reimbursement for continuing medical education
• 401k with match (coming soon)
• Health, dental, and vision insurance
• Family friendly policies that support paid parental leave and flexible work arrangements.
• As a team member you’ll be supported by our robust commitment to training and development that starts with onboarding and continues throughout your career. You will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of our company’s high-quality, value-based, care model