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Quality Reviewer, Diagnosis Accuracy
Job Description
Park Nicollet is looking to hire a Diagnosis Accuracy Quality Reviewer to 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 risk-adjustment methodologies. The DA QR provides structured, data-driven 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 master's 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
- Maintain a current, active, unrestricted state license/certification as a Nurse Practitioner, Physician Assistant, or Registered Nurse
- 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 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
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
- In-depth 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!
About Us
At HealthPartners 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 HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Benefits Designed to Support Your Total HealthAs a HealthPartners colleague, we're committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.
Join us in our mission to improve the health and well-being of our patients, members, and communities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.
