Diagnosis Accuracy Clinical Reviewer

HealthPartners is hiring a Diagnosis Accuracy Clinical Reviewer. This role is a highly skilled clinician to support the ongoing work of the Diagnosis Accuracy Program. The individual will review patient records to assess diagnosis code specificity, identify documentation and coding opportunities based on supporting clinical evidence, and validate suspect conditions.

MINIMUM QUALIFICATIONS:

• Education, Experience or Equivalent Combination:
  
  
  
  • Advanced Practice Clinician either Master of Science in Nursing degree (Nurse Practitioner), Physician Assistant (PA), or Master's prepared Registered Nurse (RN) with clinical coding experience
  • Minimum two years clinical experience
  
  
• Licensure/ Registration/ Certification:
  
  
  
  • Maintain a current, active, unrestricted state licensed/certification as a Nurse Practitioner (NP), Physician Assistant (PA), or Registered Nurse (RN)
  
  
• Knowledge, Skills, and Abilities:
  
  
  
  • Strong clinical background with indepth knowledge of medical terminology, pathophysiology, pharmacology, and disease interactions, supported by sound clinical judgment and ability to interpret complex medical information.
  • Strong and demonstrated PC skills are required along with an ability to learn new systems.
  • Experience with electronic medical record and billing modules (e.g. Epic)
  • Strong verbal, and written communication, skills
  • Ability to work with others and develop consensus among differing parties.
  • Knowledge of ICD-10 diagnosis coding, clinical documentation requirements, and clinical documentation improvement concepts
  • Ability to self-direct work, detail orientated and organized
  • Ability to manage and impart confidential information
  
  

PREFERRED QUALIFICATIONS:

• Education, Experience or Equivalent Combination:
  
  
  
  • NA
  
  
• Licensure/ Registration/ Certification:
  
  
  
  • Recommend Certified Professional Coder (CPC) or Certified Coding Specialist (CCS-P) Certification, AHIMA accredited Registered Health Information (RHIT), or Registered Health Information Administer (RHIA), Certified Documentation Expert - Outpatient (CDEO)
  • Recommend Certified Risk Coder (CRC) certification
  • Certified Clinical Documentation Specialist - Outpatient (CCDS-O)
  
  
• Knowledge, Skills, and Abilities:
  
  
  
  • Knowledge of multiple payment and risk adjustment methodologies used by government and commercial payers
  • Ability to work collaboratively with others
  • Ability to work in an ever-changing environment with differing perspectives and ability to resolve situations effectively
  
  

ESSENTIAL DUTIES:

1. (75%) - Conduct chart review of patient medical records prior to clinic visits including chart notes, labs, medications, x-rays, etc. This includes reviewing clinical criteria, suspect conditions, updating the patient problem list, and evaluation of outreach opportunities.
2. (10%) - Support chart reviews outside the clinic visit including payer identified reviews.
3. (10%) - Support program on clinically focused projects (e.g., best practices, quality, condition specific chart reviews, condition specific tools).
4. (5%) - Other duties as assigned.