Clinical Quality Consultant

Clinical Quality Consultant

The Clinical Quality Consultant (CQC) is a Nurse Practitioner for quality documentation, coding, and value capture. The CQC will focus on chart reviews by supplying clinical expertise to ensure full, accurate and appropriate diagnosis, documentation, coding, and care that more precisely reflects the true risk level of the patients we serve. The CQC will review all provider visit medical encounters and apply the most accurate diagnosis codes (ICD-10 codes). This position reports to the Director Clinical Services, Performance and Quality.

Responsibilities:

• Reporting directly to the Director of Clinical Services, Performance and Quality, overall accountability for HCC/Risk Adjustment performance and Quality Documentation.
• Liaison to coding team
• Liaison with other clinical teams on alignment of goals and workflows to support value capture initiatives and high-quality clinical documentation.
• Chart reviews for closing HEDIS care opportunities to ensure practice and health plan success.
• Fully understands coder workflow.
• Participates in Peer Review of medical documentation for completed visit notes as well as patient profile information (problem list, medications, allergies, etc.) in EMR.
• Reviews and corrects any ICD-10 codes that have been assigned in the chart.
• Provides feedback to the provider on opportunities for improved documentation to support specific codes.
• Maintains excellent punctuality and attendance during work hours.
• Other duties as assigned.

Qualifications:

Required:

• Nurse Practitioner with current license – any state OR Doctor – Foreign Medical Graduate not currently able to practice in US.
• At least 3 years' experience in applying appropriate diagnosis in the Medicare HCC model.
• Expertise with the most current CMS Risk Adjustment Model.

Preferred:

• AAPC Certified Risk Adjustment Coder (CRC™) is preferred but required

Those who thrive at CareBridge tend to possess these qualities:

• An entrepreneurial spirit. Must be a tenacious self-starter.
• Flexible and adaptable to a constantly changing workload.
• Must enjoy working in a fast-paced environment.
• A sense of humor and down-to-earth nature.

Employment Type: Full-Time

Location: Remote

Physical Demands / Working Conditions: Work is performed in a normal office environment. Requires sitting for long periods of time. Requires hand-eye coordination and manual dexterity sufficient to operate a telephone, keyboard, calculator, and other office equipment. Work is often performed under stressful situations.

About CareBridge

CareBridge provides technology and services that assist payers and states in caring for patients with physical, intellectual, and developmental disabilities. CareBridge's services include 24/7-member support, benefits management, electronic visit verification (EVV), and data aggregation. CareBridge is led by a healthcare service and technology veterans team and is headquartered in Nashville, Tennessee.

We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.