What are the responsibilities and job description for the Clinical Quality Assurance RN position at River Valley Home Health and Hospice?
Clinical Quality Assurance RN
JOB SUMMARY
The Clinical Quality Assurance RN is responsible for analyzing data integrity and consistency of OASIS documentation and assessment processes. This position will ensure appropriate ICD-9 - ICD-10 coding and sequencing and will work with clinical staff to clarify documentation and data integrity issues.
DUTIES & RESPONSIBILITIES
1. Prospectively reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy.
2. Utilizes OASIS variation or alert reports when reviewing OASIS data.
3. Ensures appropriate ICD-10 coding and sequencing as it relates to the patient's medical condition, including any co-morbidities.
4. Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections per organization policy.
5. Reviews visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and / or underutilization to the clinical manager / designee.
6. Notifies OASIS Review Nurse and Agency Managers of problematic trends as a result of OASIS review.
7. Works collaboratively with nursing supervisors to assure documentation is complete and consistent with care and reflects legal requirements.
8. Provides education / mentoring to clinical staff regarding trends and issues within assessments.
9. Collaborates with nursing supervisors to provide a process to promote and ensure employee orientation, competency, and in-service education programs
10. Participates in Quality Improvement and Corporate Compliance activities as assigned.
11. Assists with other chart audit activities as assigned.
12. Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications.
13. Follow written and oral instructions
14. Maintain patience, tact, cheerful disposition and enthusiasm
15. Must comply with all training requirements
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by the employee of this job. The employee may be requested to perform job-related tasks other than those stated in this description.
JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities)
1. 1-2 years of experience of home health clinical, coding, or billing experience required.
2. Working knowledge of OASIS and ICD-10 coding. OASIS certification (COS-C) preferred; OASIS Home health ICD-10 coding certification preferred.
3. Knowledge of federal regulations and state licensure requirements.
4. Working knowledge of computer systems.
5. Possess and maintains current CPR certification.
6. Licensed driver with automobile that is in good working order and insured in accordance with organization requirements.
7. Excellent coordination and communication skills.
8. Detail oriented and able to work with minimal supervision.
