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Provider Consultant

  • Las Vegas, Nevada, United States
Program Management

Job description

As a Provider Consultant, you will operate as the “boots on the ground” Care Team member for specified medical practices. You will be responsible for managing the end-to-end workflow to support the deployment and reconciliation of clinical documentation alerts. This includes, but is not limited to, liaising with providers and office staff, retrieving medical records, scanning, and uploading pertinent clinical documentation, responding to risk-adjustment inquires, and overseeing general provider education and engagement efforts. 

Essential Duties and Responsibilities

  • Operate as the primary contact for specified outpatient medical practices to ensure CDI Alert deployment & appropriate provider engagement.
  • Navigate available EMR and paper systems to ensure the Care Team has the requisite patient clinical documentation on regular basis to support work efforts.
  • Align with the Client Delivery Manager to ensure CDI Alert distribution and reconciliation protocol is followed in accordance with the established workflow and patient scheduling for the specified practice.
  • Submit daily reports to the Care Team enabling effective management of CDI Alert deployment, response, medical record (re)reviews, and case closure.
  • Actively assess program performance at the ground level and immediately notify the Care Team of challenges hindering success.
  • Follow all coding and workflow guidelines specific to SWDS and the assigned medical practice under management.
  • Respond to inquiries at the provider level pertaining to ICD-10-CM diagnoses that map to a Risk-Adjusted HCC for Medicare and Medicaid.
  • Coordinate physician to physician education as needed.
  • Participate in program and process improvement activities.
  • Additional duties as necessary to meet the obligations to our clients.

Knowledge, Skills and Abilities

  • Excellent organization and problem-solving skills required. Strong oral and written communication skills required.
  • Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes
  • Knowledge of ICD-10-CM coding guidelines is required.
  • Advanced technical skills for use of MS Office (Excel, Word, Outlook and PowerPoint)
  • Demonstrated ability to utilize a variety of electronic medical records systems.
  • Ability to manage significant workload, and to work efficiently under pressure meeting established deadlines with minimal supervision.
  • Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization.
  • Strong time management skills.
  • Must possess high degree of accuracy, efficiency and dependability.
  • Excellent written and oral communication for representation of clear and concise results.


  • Las Vegas, NV area
  • Required to work from home as well as in provider offices. Daily travel is required to various sites and personal automobile will be required where public transportation is not available/used. After-hour meetings may be required.

Job Benefits

  • Health insurance
  • Vision insurance
  • Dental insurance
  • Life insurance
  • Simple IRA matching
  • Paid time off

Job requirements

Qualification Requirements

  • Minimum of 5 years of medical office experience.
  • Knowledge of Medicare, Medicaid, and Commercial Risk Adjustment (HCCs), guiding principles, and reimbursement methodology preferred.
  • Valid driver's license.