Clinical Reviewer - Medical Coder & QA

It's fun to work in a company where people truly BELIEVE in what they're doing!

Our intention is to have employees who are passionate about making their personal mission statement come to life each day at work!  Be it through providing healing, eradicating loneliness, contributing to efficiencies, streamlining processes, being dependable, sparking creativity or something else, the demonstration of HOW you do your job is just as important as WHAT you do in your job.

Alongside our valued employees, we are making a difference throughout the state of Ohio in the lives of those that need healthcare or those embracing the next chapter of their lives. Sustained members of our team demonstrate accountable behavior and share our values of customer service, innovation, inclusion, integrity, financial stewardship, leadership and care.

The Clinical Reviewer reviews and approves of all patient information that is provided by the licensed professional during a start of care, recertification, resumption of care, or evaluation visit while promoting quality patient care, ensuring stable relationships with referral sources, patients, caregivers, and staff members, and assists with the training agency staff in accordance with company standards and federal, state, and local standards, guidelines, and regulations.

Essential Activities and Tasks 

Clinical Practice and Documentation - 80%

• Responsible to process Home Health Starts of Care (SOC) or Hospice Admission Plans of Care timely working with their assigned Home Health and Hospice office.

• Maintains accepted productivity of all Plans of Care.  Assists other Clinical Reviewers as needed to ensure Ohio Living Home Health and Hospice as a whole keeps within accepted benchmarks for Plan of Care completion and provider approval.

• Completes review of evaluation packets, OASIS-C, 485s and other clinical information for home health and hospice ensuring consistency with the comprehensive assessment of the 485.

• Reviews both the data submitted from the field staff to ensure accuracy and follows up on any documentation that requires correction.

• Completes ICD-10 coding based on clinical documentation in accordance with company standards and federal, state, and local standards, guidelines, and regulations.

• Ensures that service utilization correlates with the assessment data.  

• Processes the OASIS and verifies the correct start of care date and episode date range.

• Processes any unlisted supplies, medications, activity, functional limitations, allergies, etc. that appear on the action screen to ensure completion of the 485.

• Ensures that appropriate care types and Plan of Care (POC) are selected based on the patient’s medical condition and the staff’s assessment data.

• Reviews Resumption of Care (ROC) and Discharge Assessment Data to ensure accuracy and follows up on any documentation that requires correction.

• Processes the ROC and discharge OASIS.

• Ensures that the patient’s POC is completed and reassessed by the appropriate health care professional when there is a significant health status change in the patient’s condition at the physician’s request and after hospital discharge. Ensures appropriate documentation is completed for all patients transferred to an inpatient facility.

• Assists the clinical management staff with conducting OASIS and documentation portions of the job-specific orientation as requested.  Assists with identification of and then provides additional training for employees on OASIS documentation.  Keeps clinical management staff apprised of any additional training needs for staff members.

• Serves as a clinical resource to the Home Health Clinical Supervisors as well as the clinical teams for coding and clinical documentation.

• Evaluates and processes add-on visits to SOC and ROC.

• Processes hospice SOC and the Hospice Item Set to prepare required information for billing.

• Participates in orientation of newly hired Clinical Reviewers as requested.

Quality and Compliance Management - 20%

• Maintains current and accurate records through use of computers and/or other documentation in accordance with company standards and federal, state, and local standards, guidelines, and regulations.

• Maintains knowledge of requirements of regulatory agencies, accrediting bodies, and third party payers.

All other duties as assigned.

Qualifications

Education

• High school diploma or equivalent required.

• Two years of post-secondary education in a clinical specialist or medical records program or Certificate for OASIS Specialist-Clinical (COS-C) designation from OASIS Certificate and Competency Board (OCCB).the OASIS Certificate and Competency Board (OCCB) required.

• Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred Certificate for OASIS Specialist-Clinical Certificate for OASIS Specialist-Clinical Certificate for OASIS Specialist-Clinical.

• Certification in ICD-10 diagnosis coding required or willing to obtain within six months of hire.

Experience

• Two years of medical-surgical, medical records management, or healthcare billing experience required.

• Experience with ICD-10 medical coding required.

• Experience in a Medicare-certified home health agency preferred.

• Proficiency with Windows, Microsoft Office (Word, Excel, PowerPoint), and the internet required.

Other Requirements

• Must be able to read, write, speak, and understand the English language.

Working Conditions and Special Requirements

• Sitting - Up to 8 hours/day

• Standing - Up to 2 hours/day

• Walking - Up to 2 hours/day

• Lifting, pushing, pulling, and moving equipment, supplies, etc - Up to 25 pounds

• Risk Category for Exposure to Bloodborne Diseases - III