Pre-Visit Support RN – HCC/Risk Adjustment

Medasource; United States; On-site; USD 75,000 - 95,000; Full time

Job summary

Medasource seeks a Pre-Visit Support Registered Nurse (RN) to assist physicians and care teams by conducting comprehensive pre-visit reviews of patient records for HCC capture and risk adjustment. You will review historical diagnoses, lab results, and medications to build a concise risk profile the physician can act on, ensuring documentation is complete, specific, and compliant.

This role emphasizes collaboration with clinicians, independent work, and proficiency with electronic health records

Qualifications

• Current RN license in good standing.
• Clinical nursing experience with ability to interpret complex medical records.
• Strong understanding of chronic disease management and clinical documentation.
• Excellent attention to detail and ability to identify clinically relevant information across multiple sources.
• Proficiency with electronic health records and standard clinical information systems.

Responsibilities

• Conduct comprehensive pre-visit reviews of assigned patient records to identify clinically supported documentation opportunities related to HCC capture and risk adjustment.
• Review historical diagnoses, problem lists, prior encounter documentation, laboratory results, imaging studies, medications, specialist notes, and other relevant clinical information to develop an accurate patient risk profile.
• Identify chronic and complex conditions that may require annual recapture, assessment, monitoring, evaluation, or treatment during the current encounter.
• Evaluate clinical documentation for completeness, specificity, consistency, and clinical support.
• Identify documentation gaps that may affect risk-adjustment accuracy, quality reporting, or the completeness of the patient's medical record.
• Identify chronic conditions supported by the medical record that may qualify for HCC capture based on CMS and organizational requirements.
• Review documentation to determine whether identified conditions are appropriately supported by the clinical record and require assessment during the patient encounter.
• Prepare and communicate relevant pre-visit findings to physicians and care teams in a concise, clinically meaningful format.
• Support physicians in addressing identified documentation opportunities through accurate, specific, and compliant clinical documentation.
• Support closure of identified risk-adjustment gaps through collaboration with physicians and clinical teams.

Skills

RN license

Clinical experience

Chronic disease mgmt

Clinical documentation

EHR proficiency

Communication

Independent work

Education

Bachelor's degree in Nursing (BSN)

Tools

Epic

Job description

The Pre-Visit Support Registered Nurse (RN) supports physicians and care teams by conducting comprehensive pre-visit reviews of assigned patient records to identify clinically supported documentation opportunities related to Hierarchical Condition Categories (HCC) and risk adjustment.

The RN reviews the patient's historical clinical information and develops a concise, actionable risk profile for the physician prior to the patient encounter. This includes identifying chronic and complex conditions that may require annual assessment, monitoring, evaluation, or treatment and ensuring that relevant clinical information is available to support accurate, complete, specific, and compliant documentation.

The Pre-Visit Support RN serves as a clinical resource to physicians and care teams, helping to close identified risk-adjustment and documentation gaps while supporting the accuracy of the patient's medical record, quality reporting, and overall care planning.

Responsibilities:

• Conduct comprehensive pre-visit reviews of assigned patient records to identify clinically supported documentation opportunities related to HCC capture and risk adjustment.
• Review historical diagnoses, problem lists, prior encounter documentation, laboratory results, imaging studies, medications, specialist notes, and other relevant clinical information to develop an accurate patient risk profile.
• Identify chronic and complex conditions that may require annual recapture, assessment, monitoring, evaluation, or treatment during the current encounter.
• Evaluate clinical documentation for completeness, specificity, consistency, and clinical support.
• Identify documentation gaps that may affect risk-adjustment accuracy, quality reporting, or the completeness of the patient's medical record.
• Identify chronic conditions supported by the medical record that may qualify for HCC capture based on applicable CMS and organizational requirements.
• Review documentation to determine whether identified conditions are appropriately supported by the clinical record and require assessment during the patient encounter.
• Prepare and communicate relevant pre-visit findings to physicians and care teams in a concise, clinically meaningful format.
• Support physicians in addressing identified documentation opportunities through accurate, specific, and compliant clinical documentation.
• Support closure of identified risk-adjustment gaps through collaboration with physicians and clinical teams.

Skill Set Requirements:

• Current Registered Nurse (RN) license in good standing.
• Bachelor's degree in Nursing (BSN) preferred.
• Clinical nursing experience with demonstrated ability to interpret complex medical records and apply clinical judgment.
• Strong understanding of chronic disease management and clinical documentation.
• Excellent attention to detail and ability to identify clinically relevant information across multiple sources within the medical record.
• Strong written and verbal communication skills.
• Ability to work independently while effectively collaborating with physicians and multidisciplinary teams.
• Proficiency with electronic health records and standard clinical information systems.

Nice to Haves:

• Experience with HCC coding, risk adjustment, clinical documentation improvement (CDI), or value-based care.
• Experience conducting medical record reviews or chart audits.
• Familiarity with CMS risk-adjustment methodologies and documentation requirements.
• Experience with Medicare Advantage or other risk-adjusted populations.
• Experience with Epic or another enterprise electronic health record.
• Experience in population health, care management, quality improvement, ambulatory care, or physician practice support.
• Certification or formal training in CDI, coding, HCC/risk adjustment, or related areas.