The Home Care Quality Assurance and Coding Review Clinician is responsible for assisting the PI Manager in ensuring excellent clinical outcomes and accurate HHRG Coding. This position performs reviews of OASIS assessment and 485 for completeness and accuracy with coding based on ICD and CPT classification systems. In addition, this position is responsible for abstraction of patient records according to coding requirements and procedures, utilizing SHP as a tool to review Coding and OASIS inaccuracies and make recommendations for changes.

RESPONSIBILITIES:

• Reviews all admissions, discharges, and recertifications where appropriate.
• Correctly codes diagnoses and procedures on all admissions using ICD-9(10) coding.
• Compares chart documentation with Oasis documentation and ensures that coding and OASIS documentation follows all federal & state regulations.
• Works with the Team Managers and PI Manager in conducting chart audits flagged for coding and OASIS accuracy issues.
• Performs quality improvement measures and utilization review of medical records under the supervision of the PI Manager.
• Functions as needed for all locations and participates in quality improvement projects.
• Audits medical records and provides reports based on coding and documents results as needed.
• Completes comprehensive order review and advises if corrections are needed to field staff.
• Performs other duties as assigned.

QUALIFICATIONS / REQUIREMENTS:

Experience:

Minimum of 5 years field experience. Proficient with Coding, OASIS, and Home Health Prospective Payment System (PPS).

Education:

Bachelor’s degree from an accredited School of Nursing, Physical Therapy, or Occupational Therapy.

Licenses / Certifications:

Currently licensed as a Registered Nurse, Physical Therapist, or Occupational Therapist in the state of New York.

Other:

If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.