What are the responsibilities and job description for the Clinical Documentation Review Professional position at Granite VNA, Inc.?
Description
Current opening: Full time 40 hours per week, Monday - Friday 8a-4:30p. Primarily Remote.
Position Overview
Reporting to the Director of Quality, the Clinical Documentation Review Professional performs clinical review of medical records and all documentation to determine the accuracy and appropriateness of program, regulatory and billing requirements for provided services; participates in the agency’s clinical education program as needed by presenting educational programs that will enhance the clinical staff’s knowledge of clinical documentation requirements.
Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Performs in-depth analysis and review of medical records requiring professional clinical judgment, to determine medical necessity and program compliance with appropriate completion and follow through in accordance with agency policy and Medicare Conditions of Participation.
- Reviews and prioritizes ICD-10 Coding of diagnosis on certifications, resumption of care, recertification and discharge documentation.
- Researches, verifies and corrects problems, if applicable, on OASIS and lock OASIS documents upon completion of review and/or edits.
- Upon the request of management completes a clinical review of specific clinician clinical documentation to ensure that the documentation is complete, meets agency’s standards and reflects the patient’s plan of care and stated goals and meets program compliance.
- Participates as a presenter in the Agency’s clinical education program by providing education about clinical documentation requirements as needed.
- Completes the clinical review for any request for medical record documentation from Medicare, Medicaid, or other third party, includes but is not limited to ADR, CERT and/or RAC audit request as needed.
- Reviews and prepares appeals for any denials for services based on medical necessity or non-compliance in regards to clinical and/or Medicare related issues as needed.
- Demonstrates knowledge of the Medicare COP, PDGM and OASIS requirements.
- Provides appropriate structured written documents/reports of individual review and research findings along with overview reports that are understandable to a variety of audiences with differing levels of understanding and reading ability.
Other Job Functions
- Utilizes the appropriate regulations necessary to complete the medical record review.
- Maintains compliance with the Health Insurance Portability and Accounting Act (HIPAA) for all audit documentation.
- Participates in the Agency’s QI projects as requested.
- Demonstrates flexibility in the role by accepting other duties as assigned for which qualified.
- Adheres to the Agency’s policies and procedures.
Requirements
1. A Registered Nurse, Occupational Therapist, or Physical Therapist licensed in the State of NH
2. Knowledge of ICD-10 and prior coding experience strongly preferred
3. Completion of ICD-10 coding course and certification exam within 1 year of hire
4. Knowledge of Clinical Standards of Care and documentation requirements
5. Knowledge of OASIS datasets
6. OASIS certification within one year of hire
