Diagnosis Accuracy Clinical Reviewer

Job Description

Health Partners is hiring a Diagnosis Accuracy Clinical Reviewer. This role is a h ighly skilled clinician to support the ongoing work of the Diagnosis Accuracy Program. The individual will review patient records to assess diagnosis code specificity, identify documentation and coding opportunities based on supporting clinical evidence, and validate suspect conditions.

• Education, Experience or Equivalent Combination:
  • Advanced Practice Clinician either Master of Science in Nursing degree (Nurse Practitioner), Physician Assistant (PA), or Master’s prepared Registered Nurse (RN) with clinical coding experience
  • Minimum two years clinical experience
• Licensure/ Registration/ Certification:
  • Maintain a current, active, unrestricted state licensed/certification as a Nurse Practitioner (NP), Physician Assistant (PA), or Registered Nurse (RN)
• Knowledge, Skills, and Abilities:
  • Strong clinical background with in‑depth 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 are required along with an ability to learn new systems.
  • Experience with electronic medical record and billing modules (e.g. Epic)
  • Strong verbal, and written communication, skills
  • Ability to work with others and develop consensus among differing parties.
  • Knowledge of ICD-10 diagnosis coding, clinical documentation requirements, and clinical documentation improvement concepts
  • Ability to self‑direct work, detail orientated and organized
  • Ability to manage and impart confidential information

• Education, Experience or Equivalent Combination:
  • NA
• Licensure/ Registration/ Certification:
  • Recommend Certified Professional Coder (CPC) or Certified Coding Specialist (CCS-P) Certification, AHIMA accredited Registered Health Information (RHIT), or Registered Health Information Administer (RHIA), Certified Documentation Expert – Outpatient (CDEO)
  • Recommend Certified Risk Coder (CRC) certification
  • Certified Clinical Documentation Specialist – Outpatient (CCDS-O)
• Knowledge, Skills, and Abilities:
  • Knowledge of multiple payment and risk adjustment methodologies used by government and commercial payers
  • Ability to work collaboratively with others
  • Ability to work in an ever‑changing environment with differing perspectives and ability to resolve situations effectively

• (75%) - Conduct chart review of patient medical records prior to clinic visits including chart notes, labs, medications, x-rays, etc. This includes reviewing clinical criteria, suspect conditions, updating the patient problem list, and evaluation of outreach opportunities.
• (10%) - Support chart reviews outside the clinic visit including payer identified reviews.
• (10%) - Support program on clinically focused projects (e.g., best practices, quality, condition specific chart reviews, condition specific tools).
• (5%) - Other duties as assigned.

At Health Partners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We’re a nonprofit, integrated health care organization, providing health insurance in six states and high‑quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through Health Partners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At Health Partners, everyone is welcome, included and valued. We’re working together to increase…