Quality Assurance Nurse

Job description- Remote for US residents 

Our Mission at Pinnacle Home Care is "Changing lives through the art of the experience"!! Pinnacle Home Care is a full-service Medicare Certified and Florida Licensed Home Health Company locally owned and operated by home health professionals who are passionate about delivering exceptional, quality care to the communities that we serve. We take pride in our home health care professionals who are devoted to fulfilling the levels of service that we uphold. Human service can never be successful without dedication, just as dedication cannot be realized without passion.

Why Join us:

• Unlimited PTO for salaried employees which means more family time, fun and relaxation.
• Award-winning – Top places to work (2020, 2021, 2022 & 2023), Healthcare workplace Innovator, Top 100 Agency Home Care Elite
• Leading provider of home care services recognized for Creating Raving Fans and delivering Exceptional Outcomes.
• 401K Match and Additional benefits
• Mileage reimbursement.
• Referral bonuses.

(Rules apply to PTO and 401K)

Live QA Specialist

The Company reserves the right to modify, add or change duties of the position at any time.

Job Title/Position: Live QA Specialist

Reports To: Director of Quality and Clinical Outcomes

Job Location: Remote from Home

JOB DESCRIPTION SUMMARY:

Provides coding expertise to Agencies assigned for ICD-10 coding, reviewing OASIS, Plan of Care review, process & outcome measures, Star Rating items and all pertinent documentation to ensure accurate coding for each patient and ensures that all applicable Federal laws are followed. Applied knowledge of medical terminology, disease processes, and pharmacology required. This individual will be required to make independent decisions regarding accurate ICD10-CM code assignments, OASIS and Plan of Care (POC) recommendations. The Coder review will play a key role in determining the reimbursement potential of Pinnacle Home Care to which they are assigned and adherence to coding standards and regulations and corporate policies developed to ensure accurate billing.

Essential Duties and Responsibilities:

The statements below are only meant to be a representative summary of the major duties and

responsibilities performed by incumbents in this job. The incumbents may be requested to perform job related tasks other than those stated in this description.

• Performs centralized coding for Pinnacle Home Care agencies via scanned medical records and clinician documentation via EMR data.
• Provides Home Health coding, OASIS, POC and quality review for assigned agencies. Able to make independent decisions regarding accurate ICD-10-CM coding and OASIS, POC and quality data assignments.
• Reviews records, recommending changes for clinician review and acceptance, based on CMS regulation, industry standards and coding convention as supported by documentation.
• Reviews plan of care for accuracy and quality and make needed recommendations.
• Applies knowledge of medical terminology, disease processes, and pharmacology.
• Assess/review assessments for coding accuracy based on documentation, CMS regulations and coding conventions, OASIS compliance and Plan of Care quality and accuracy.
• Maintain minimal productivity number standards daily.
• Codes all assessments using ICD-10-CM (SHP, and Decision Health Coding Pro software) as well as appropriate industry references.
• Consults Senior Director and works out difficult codes and/or coding problems as needed.
• Attend/participate in continuous learning and education in ICD-10 coding, OASIS, Quality and Plan of Care development as necessary. Keeps abreast of regulatory changes and communicates these changes to Senior Director, Coding.
• Meet or exceed minimum auditing and productivity scores for coding quality and compliance. Maintain quality of coding review with a score of 90% or greater on monthly and/or quarterly quality audits.
•  Plan, prioritize, organize and complete work to meet established objectives.
• Should be good steward of all company financial resources, including but not limited to arrangements for equipment and other necessary items and services needed.
• Performs duties in accordance of, and under the direction/supervision, as defined by the company organizational chart.
• Assists on a variety of special projects and other duties as needed.
• Follows agency policies and procedures. Maintains confidentiality of patients and agency information per HIPPA requirements.
• Completes and submits all documentation in a timely manner according to department policy.
• Attends in-service and education as required.
• Adheres to Federal/State guidelines rules regulations, statutes and law.
• Follows the Code of Conduct policy.
• Complies with corporate and departmental policies and procedures.

POSITION QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Licenses/Certifications:

• Formal clinical background required, RN required, with current state nursing licensure.
• Nationally accredited Coding ICD-10 certification required.
• Nationally accredited OASIS- certification required.
• Valid driver’s license and auto insurance
• Must complete required departmental competencies to validate and maintain competency.
• Computer Skills:
• To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software.
• Must be proficient in the use of a PC, web-based portals and Microsoft Office Suite (Access, Excel, Outlook, Power Point and Word).
• Knowledge of SHP and/or Decision Health Coding Pro is a plus.

The Company reserves the right to modify, add or change duties of the position at any time.

Education/Experience Education:

Associates degree or greater in a clinical program required with formal clinical background required, RN license required.

Experience:

• Minimum of three (3) years on-going coding and abstracting experience in ICD-10-CM for Home Health agencies preferred.
• Clinical home health experience preferred.
• Experience with OASIS analysis preferred.

 JOB ACCEPTANCE STATEMENT

I have reviewed these job requirements and verify I can perform the minimum requirements and essential functions of this position. I have read, understand and agree to the terms specified in the job description for the above-named position. A copy of this job description has been given to me. I further understand that this job description may be reviewed at any time and that I will be provided with a revised copy.