job title: Prospective chart review quality editor(agilon)

Job Description: ​

• Performs audits of pre-visit medical record reviews to identify chronic conditions reported in prior years and conditions that lack supporting documentation.

• Evaluates suggestions or clinical alerts presented by Prospective Chart reviewers, ensure that these suggestions meet specificity requirements to support clinical indicators and in compliance with Risk Adjustment documentation standards.

• Conducts review and communicates feedback to professionals such as Clinical Chart Reviewers and third-party vendors.

• Responds to questions submitted by Prospective Chart reviewers.

• Document detailed audit findings including all errors and missed opportunities in the Prospective chart reviews.

• Correlate activities, processes and HCC results/ metrics to evaluate outcomes.

• Assist in developing workflows, curriculum and policies and procedures related to the Pre-visit Medical Record review team.

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.

• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.

• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.

• Engage in excellent communication which includes listening attentively and speaking professionally.

• Set and complete challenging goals.

• Demonstrate attention to detail and accuracy in work product.

Required Qualifications:

Minimum Experience

• 2+ years of clinical experience required

• 5+ year of chart review and medical coding/auditing experience required

• Advanced level of clinical knowledge associated with chronic disease states required

Education/Licensure:

• Medical doctor or Nurse required

• Coding Certification through AHIMA or AAPC required

• CPC or CPMA preferred