Location: all cities,WA, USA
Description Under the supervision of the Quality Integrity Program Manager, the RN - Clinical Data Reviewer (HCC) improves data quality and appropriately risk stratify the populations in value based contracts and provide better patient care by reviewing medical records to determine if there are any gaps in documentation. The RN- Clinical Data Reviewer understands audit requirements and governing policies and regulations related to ICD-10 coding and clinical documentation integrity. This position is an integral part of a record review process analyzing cases and will query providers about any gaps to clinically validate or clarify diagnosis criteria in the documentation and record appropriate ICD-10 diagnosis coding. An understanding of risk adjustment models and hierarchical condition category (HCC) coding is necessary. Provides feedback and education to the HCC Coding Auditors and providers based on the reviews. This position will also be able to follow trends in ambulatory/outpatient clinic documentation review, integrity, and coding and will be able to identify and assess educational needs and then provide appropriate training. Also, assists in creating educational materials for coding changes, updated coding guidelines, and strategies. Assists Population Health leadership in developing new data projects and elements for the collection, monitoring and reporting of both clinical and Quality Improvement outcomes. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Group Southwest Washington and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required qualifications: Bachelor's Degree or BSN Coursework/Training: Sufficient for RN licensure 3 years Nursing experience in a hospital or physician practice environment Required upon hire: Washington Registered Nurse License Preferred qualifications: Preferred upon hire: Certified Risk Adjustment Coder (CRC) Or Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of Know me, care for me, ease my way. Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. About the Team Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers. PCN is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington's greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence's St. John's Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 316675 Company: Providence Jobs Job Category: Clinical Quality Job Function: Quality/Process Improvements Job Schedule: Full time Job Shift: Day Career Track: Nursing Department: 3032 ACCOUNTABLE CARE WA Address: WA Olympia 1018 Capitol Way 301 Work Location: Union Heights-Olympia Workplace Type: Remote Pay Range: $47.98 - $75.94 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.