Quality Documentation Reviewer

Evergreen Nephrology

Evergreen Nephrology

Quality Assurance
Nashville, TN, USA
Posted on Tuesday, September 12, 2023

Who You Are

You are devoted, compassionate, and enjoy being on the front lines in healthcare, changing the lives of your patients. You are passionate about getting to the root cause of a patient’s conditions, removing social determinants of healthcare, and ensuring the highest possible quality of life for those in your care. You don’t want to sacrifice quality over quantity, and you aim to provide the same level of care and commitment to your patients that you would to your own family member. Does this sound like you? If so, we should talk.

Who We Are

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care and we are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.

We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients.

We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.

Your Role

As a Quality Documentation Reviewer, you will partner with physician offices, vendors and APP's within our established partnerships to assess the health information that includes improving clinical documentation, quality measures, and regulatory guidelines. The Quality Documentation Reviewer will work in collaboration with the Medical Coder, as appropriate. You serve as a subject matter expert in clinical documentation, quality measures, and regulatory guidelines.

Primary functions for the Quality Documentation Reviewer include:

  • Work collaboratively with physicians, Advanced Practice Practitioners, other healthcare professionals, and coding staff to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes, and quality is captured for the level of service rendered to all patients.
  • Audit clinical documentation and coded data to validate documentation supports diagnoses, procedures, and treatment as well as identifies deficiencies of evidence-based practices.
  • Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future documentation discrepancies.
  • Serves as a resource for documentation improvement
  • Apply critical thinking and decision-making skills to determine if the medical record documentation supports the need for service while maintaining production goals and quality standards.
  • Assists management with training new Quality Documentation Reviewers to include daily monitoring, mentoring, feedback, and education.
  • Attend training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
  • Actively demonstrates the organization’s mission and core values and conducts oneself at all times in a manner consistent with these values.
  • Knows and adheres to all laws and regulations pertaining to patient health, safety, and medical information.

How You Qualify

  • You reviewed the Who You Are section of this job posting and immediately felt the need to read on. That makes you a match for our innovative culture.
  • Current RN License is required with an additional certification such as CDEO, CDIP, CPC, or CRC certification
  • CMS HCC Risk Adjustment experience.
  • 1+ years of auditing experience.
  • 3+ years of clinical practice in a hospital, home care, or nursing home setting.
  • Demonstrated experience in reviewing clinical documentation chart audits.
  • Demonstrates an understanding of current Quality Measure Initiatives including Value Based Care.
  • Demonstrates knowledge of pathophysiology, disease management, and coding guidelines.
  • Working knowledge of HIPAA Privacy and Security Rules.
  • You accept that things change quickly and are willing to pivot quickly on priorities.
  • Experience with EMR systems such as EPIC, Athena, Medent, Acumen, and Allscripts.
  • Demonstrated proficiency in computer skills, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, Microsoft Teams.
  • Strong people skills and ability to build supportive relationships with providers.
  • Outstanding organizational skills and an ability to operate efficiently and independently.
  • A sound knowledge of medical coding guidelines and regulations, including compliance and reimbursement. This allows for a clear understanding of the impact of coding on payment models.
  • A thorough understanding of anatomy, pathophysiology, and medical terminology necessary to correctly code using CPT, ICD-10, and HCPCS Level II coding systems.

How You are Supported

  • You will benefit from Evergreen Nephrology’s exceptional total rewards package, including competitive base pay with bonuses, paid time off starting at 4 weeks for full time employees, 11 paid holidays per year, reimbursement for continuing medical education, 401k with match, health, dental, and vision insurance
  • Family friendly policies that support paid parental leave and flexible work arrangements.
  • As a team member you’ll be supported by our robust commitment to training and development that starts with onboarding and continues throughout your career with Evergreen Nephrology
  • You will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of Evergreen Nephrology’s high-quality, value-based, care model

Evergreen Nephrology is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about your EEO rights as an applicant (Opens in a new window) .

Evergreen Nephrology will not discriminate or retaliate against applicants who inquire about, disclose, or discuss their compensation or that of other applicants. United States Department of Labor. Learn more (Opens in a new window) .