JOB SUMMARY

Manage the timely review of OASIS and physician orders to ensure accuracy of documentation, appropriate reimbursement and timely filing of claims. Oversights ICD-10CM diagnosis coding to the highest level of specificity. Through review activities, focuses the agency on appropriate resource utilization and improvement of patient outcomes.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

1. Ensures review of OASIS assessments for accuracy and compliance with state and federal regulations, ACHC standards. Ensures appropriate reimbursement aligned with current OASIS guidance and patient assessment documentation.

2. Ensures accurate ICD-10CM diagnosis coding in accordance with current conventions and guidelines.

3. Ensures review of physician orders, including but not limited to the plan of care, for accuracy, completeness and appropriate resource utilization.

4. Ensures that the above activities are completed timely to facilitate timely filing of claims.

5. Ensures that OASIS documentation is exported and accepted in accordance with federal regulations so that no revenue is lost.

6. Acts as an expert resource to all agency personnel in state and federal regulations, ACHC standards and OASIS documentation.

7. Continually assesses agency compliance with state and federal regulations and ACHC standards. Recommends actions to correct identified deficiencies.

8. Assists Administrator during state or ACHC surveys.

9. Directs and participates in ongoing clinical record review as required by regulations and standards. Aggregates data and identifies trends.

10. Participates in key performance indicator (KPI) meetings and directs efforts to improve metrics.

11. Identifies trends of non-compliance with documentation, through all review activities, and works with the Education department and other agency leadership to address through education and staff performance improvement plans.

12. Provides educational programs, in-service education and conferencing opportunities for staff as needed to increase their level of effectiveness and competency.

13. Leads quarterly Performance Improvement Committee. Prepares quarterly report for submission to Corporate Director of Clinical Services. Ensures that deficiencies are addressed and that the agency is continuously working toward improved outcomes.

14. On-call requirement.

15. Performs other duties and activities as delegated.

QUALIFICATIONS

· Registered Nurse or Physical Therapist with current licensure to practice in the state of the Organization. Bachelor’s Degree or higher required.

· Three (3) to five (5) years of recent home health experience, and one (1) year of experience in a home health leadership or quality position.

· Demonstrated experience in Performance Improvement initiatives.

· Strong understanding of home health regulations and applicable standards, including OASIS documentation

· OASIS certification preferred, or willing to obtain within 12 months.

· Knowledgeable in Patient Driven Groupings Model (PDGM) payment methodology.

· Demonstrates excellent observation, verbal and written communication skills.

Job Type: Full-time

Pay: $120,000.00 - $130,000.00 per year

Work setting:

• In-person

Work Location: In person