Quality Reviewer, Diagnosis Accuracy

Park Nicollet is looking to hire a Diagnosis Accuracy Quality Reviewerto join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.

Position Summary:

The Diagnosis Accuracy Quality Reviewer (DA QR) is responsible for evaluating the accuracy completeness and clinical validity of diagnosis documentation within ambulatory care settings. This role conducts comprehensive chart audits assesses documentation and coding practices and ensures alignment with organizational standards regulatory requirements and riskadjustment methodologies. The DA QR provides structured datadriven feedback to clinicians and internal clinical review teams supporting continuous improvement in documentation quality problem list management and diagnostic accuracy. Working collaboratively with clinical operational and coding stakeholders the DA QR contributes to improved quality outcomes compliant coding practices and enhanced organizational performance through precise and reliable clinical documentation.

Required Qualifications:

Education Experience or Equivalent Combination:

• Advanced Practice Clinician either Master of Science in Nursing degree (Nurse Practitioner) Physician Assistant (PA) or masters prepared Registered Nurse (RN) with clinical coding experience

• Minimum two years clinical experience

• Minimum one-year clinical documentation chart review and ICD-10 diagnosis coding experience

Licensure/ Registration/ Certification:

• Maintain a current active unrestricted state license/certification as a Nurse Practitioner Physician Assistant or Registered Nurse

Knowledge Skills and Abilities:

• Strongclinical 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 along with an ability to learn new systems

• Experience with electronic medical record (EMR) and billing modules (e.g. Epic)

• Strong verbal and written communication skills

• Ability to work collaboratively with others (e.g. clinicians DA Operations DA Clinical Team coding professionals clinical leaders)

• Ability to work with differing perspectives and resolve situations effectively

• Knowledge of clinical documentation improvement concepts

• Ability to self-direct work detail orientated and organized

• Demonstrates critical thinking skills

• Ability to manage and impart confidential information

Preferred Qualifications:

Education Experience or Equivalent Combination:

• Clinical experience in ambulatory setting (e.g. primary care oncology pulmonary urology)
• Ambulatory clinical documentation chart review and ICD-10 diagnosis coding experience
• Recommend Certified Professional Coder (CPC) Certified Coding Specialist (CCS-P) AHIMA accredited Registered Health Information (RHIT) Registered Health Information Administer (RHIA) Certified Documentation Expert Outpatient (CDEO) Clinical Documentation Integrity Practitioner (CDIP) or Certified Clinical Documentation Specialist Outpatient (CCDS-O)
• Recommend Certified Risk Coder (CRC)
• Knowledge of multiple payment and risk adjustment methodologies used by government and commercial payers
• Strong understanding of audit concepts and principles
• Ability to work in an ever-changing environment
• Exceptional communication skills with the ability to deliver succinct clear and professional written and verbal feedback
• Ability to synthesize multiple clinical and workflow inputs and summarize findings concisely
• Exceptional attention to detail ensuring accuracy in documentation review coding validation and reporting
• Indepth understanding of clinical workflows EMR systems and supporting technologies

Licensure/ Registration/ Certification:

Knowledge Skills and Abilities:

Benefits:

Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance dental insurance a retirement program time away from work insurance options tuition reimbursement an employee assistance program onsite clinic and much more!