Our Company

BrightSpring Health Services

Overview

The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit support required to ensure timely processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all payor types striving to improve clinical documentation and minimize lost revenue. Conducts analysis on timely submission of coding reviews and supports branches to prevent edit lock OASIS to be prior to the 30-day limit. Provide support and coordination with branches if re-coding records is required for sufficient billing practices to be met. This position will also support detailed level reporting and analytics, clinical appeals, root cause analysis, and address identified trends in reasons for denials related to coding and/or OASIS related documentation. Partners with Home Health operations and customers to drive improvement in the quality of services delivered to patients.

Responsibilities

Code diagnosis accurately utilizing ICD-10 for purposes of reimbursement and compliance within coding regulations and guidelines

Identify problems and follow up as needed with appropriate staff and/or department for correction

Review coding to ensure documentation is completed within Agencys admission timeframe

Establishes and promotes ongoing communications with Agency personnel

Charged with responding, managing, and monitoring payer Additional Documentation Requests (ADR) and communications. Works with branch staff to gather required information and submits timely response to ADR requests

Monitors OASIS timing and collaborates with branch and billing staff to determine resolutions

Audits patient records for quality and compliance per applicable home health regulations for submission for pre-claim review process of Review Choice Demonstration and/or Targeted Probe and Educate records

Audits patient records for quality and compliance per applicable home health/hospice requirements or for other projects per agency need including but not limited to improvement plans as part of targeted probe and educate surveys, performance improvement programs and patient safety surveys

Formulates and submits letters of appeal. Creates an effective appeal utilizing relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines, evidence-based medicine, local and national medical management standards, and protocols

Performs ad hoc audits and reporting per request

Analyzes information gathered by audits and reports and makes recommendations for changes to or development of policy/process and education

Tracks audit result reporting results and shares with all interested stakeholders (e.g., compliance, legal, clinical support, and local operations & clinical staff)

Acts as a resource and has expert knowledge of Medicare, Medicaid, ICD-10 Coding and OASIS and other applicable regulatory requirements

Provides consultation and education for clinical staff as needed to ensure accurate, timely, compliant documentation that drives accurate billing

Qualifications

Clinical review positions will require a RN degree in nursing from an accredited or approved school

Two years of experience in health care utilization review or home health care

Clinical review will require a current license/registration by state of hire as a nurse

Successfully completed HCS-D coding certification, required and to be maintained

Successful achieve of OASIS certification, required to be maintained

Expert written and verbal communication skills

Strong presentation skills to various audiences

Strong interpersonal skills

A thorough knowledge of federal regulations and Medicare requirements is required along with analytical skills to interpret and apply regulatory requirements

Extensive knowledge of Home Health or Hospice operations, compliance requirements

Extensive experience in working with Payer requirements, ADR requests, Denials, Appeals, RAC/ZPIC responses

Ability to prioritize tasks and manage multiple projects

Strong analytical and problem-solving skills with attention to detail

Ability to utilize a personal computer and other office equipment

Proficient use of Electronic Medical Record software

Proficient use of Microsoft Office SuiteExcel, Word, and PowerPoint

Solid ability to learn new technologies and possess the technical aptitude required to understand flow for data through systems as well as system interaction

About our Line of Business

BrightSpring Health Services is a leading provider of complementary home and community-based pharmacy and health services for complex populations in need of chronic and/or specialized care. Through the companys pharmacy and provider services to seniors and specialty (including behavioral) populations, we provide comprehensive care and clinical services in 50 states to over 360,000 customers, clients and patients daily. The companys services foster greater patient and family satisfaction, improve outcomes and reduce health care system costs, and are supported by industry-leading quality outcomes. For more information, visit www.brightspringhealth.com. Follow us on Facebook (https://www.facebook.com/brightspringHS/) , Twitter (https://www.twitter.com/BrightSpringHS/) and LinkedIn (https://www.linkedin.com/company/brightspringhealth/) .

ALERT: We are aware of a scam whereby imposters are posing as employees from our company. Beware of anyone requesting financial or personal information. We take pride in creating a best-in-class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card, drivers license, bank information, or payment for work equipment, etc.) from you via text or email. If you are suspicious of a job posting or job-related email mentioning our company, please contact us at TalentAcquisition@brightspringhealth.com .

Click here (https://www.brightspringhealth.com/careers/frequently-asked-questions/) for additional FAQ information.

Job LocationsUS-KY-LOUISVILLE

ID 2024-137732

Line of Business BrightSpring Health Services

Position Type Full-Time