Clinical Data Reviewer
3 weeks ago
About the Role
The RN – Clinical Data Reviewer (HCC) plays a crucial role in improving data quality and risk stratifying populations in value-based contracts. This position involves reviewing medical records to identify gaps in documentation and ensuring compliance with ICD-10 coding and clinical documentation integrity policies.
Key Responsibilities
- Review medical records to determine if there are any gaps in documentation
- Understand audit requirements and governing policies related to ICD-10 coding and clinical documentation integrity
- Query providers about any gaps to clinically validate or clarify diagnosis criteria in the documentation and record appropriate ICD-10 diagnosis coding
- Provide feedback and education to HCC Coding Auditors and providers based on reviews
- Follow trends in ambulatory/outpatient clinic documentation review, integrity, and coding, and identify and assess educational needs
- Assist in creating educational materials for coding changes, updated coding guidelines, and strategies
- Support Population Health leadership in developing new data projects and elements for the collection, monitoring, and reporting of clinical and Quality Improvement outcomes
Requirements
- Bachelor's Degree or BSN
- 3 years Nursing experience in a hospital or physician practice environment
- Washington Registered Nurse License
Why Providence?
Providence is committed to providing a comprehensive benefits package, including a retirement 401(k) Savings Plan with employer matching, health care benefits, life insurance, disability insurance, time off benefits, and more.
About Providence
Providence is a comprehensive health care organization serving more than 50 hospitals, over 1,000 clinics, and a full range of health and social services across seven states. We are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
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