Diagnosis Accuracy Clinical Reviewer

HealthPartners; BLOOMINGTON (MN); On-site; USD 70,000 - 90,000; Full time

Job summary

HealthPartners seeks a Diagnosis Accuracy Clinical Reviewer, a highly skilled clinician who reviews patient records to assess diagnosis code specificity and identify documentation opportunities based on supporting clinical evidence. The role validates suspect conditions and contributes to ongoing improvement of the Diagnosis Accuracy Program.

Ideal candidates hold NP/PA or RN credentials with coding experience, have at least two years of clinical practice, and are proficient with Epic and

Qualifications

• Advanced Practice Clinician with NP/PA or RN with coding experience.
• Minimum two years of clinical experience.
• Maintain current NP/PA/RN licensure/certification.

Responsibilities

• Conduct chart reviews of patient records to assess diagnosis code specificity.
• Identify documentation and coding opportunities based on supporting clinical evidence.
• Validate suspect conditions and update patient problem lists.
• Support program projects and other duties as assigned.

Skills

Clinical coding

Medical terminology

Documentation improvement

Electronic medical records

Epic experience

Communication skills

Team collaboration

ICD-10 knowledge

Self-directed

Confidential information handling

Education

MSN NP/PA or MSN RN with coding experience

Two years clinical experience

Tools

Epic EMR

Job description

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 preparedRegistered 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:
  • Strongclinical background with in‑depth 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.