Clinical Reviewer - Medical Coder & QA

About the Company

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. Whether through providing healing, eradicating loneliness, contributing to efficiencies, streamlining processes, being dependable, sparking creativity, or other meaningful contributions, the demonstration of how you do your job is just as important as what you do. Alongside our valued employees, we are making a difference throughout the state of Ohio in the lives of those who need healthcare or are 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.

About the Role

The Clinical Reviewer reviews and approves all patient information provided by licensed professionals during start of care, recertification, resumption of care, or evaluation visits. This role promotes quality patient care, ensures stable relationships with referral sources, patients, caregivers, and staff, and assists with training agency staff in accordance with company standards and federal, state, and local regulations.

Responsibilities

Clinical Practice and Documentation - 80%

• Process Home Health Starts of Care (SOC) or Hospice Admission Plans of Care timely, working with assigned Home Health and Hospice offices.
• Maintain accepted productivity for all Plans of Care and assist other Clinical Reviewers to ensure Ohio Living Home Health and Hospice meets benchmarks for Plan of Care completion and provider approval.
• Complete 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.
• Review data submitted by field staff for accuracy and follow up on any documentation requiring correction.
• Complete ICD-10 coding based on clinical documentation in accordance with company, federal, state, and local standards.
• Ensure service utilization correlates with assessment data.
• Process the OASIS and verify the correct start of care date and episode date range.
• Process unlisted supplies, medications, activity, functional limitations, allergies, etc., to ensure completion of the 485.
• Ensure appropriate care types and Plan of Care (POC) are selected based on the patient’s medical condition and staff’s assessment data.
• Review Resumption of Care (ROC) and Discharge Assessment Data for accuracy and follow up on corrections as needed.
• Process ROC and discharge OASIS.
• Ensure the patient’s POC is completed and reassessed by the appropriate healthcare professional when there is a significant health status change, at the physician’s request, or after hospital discharge.
• Ensure appropriate documentation is completed for all patients transferred to an inpatient facility.
• Assist clinical management staff with OASIS and documentation portions of job-specific orientation and provide additional training for employees on OASIS documentation as needed.
• Serve as a clinical resource to Home Health Clinical Supervisors and clinical teams for coding and clinical documentation.
• Evaluate and process add-on visits to SOC and ROC.
• Process hospice SOC and the Hospice Item Set to prepare required information for billing.
• Participate in the orientation of newly hired Clinical Reviewers as requested.

Quality and Compliance Management - 20%

• Maintain current and accurate records through use of computers and/or other documentation in accordance with company, federal, state, and local standards.
• Maintain knowledge of requirements of regulatory agencies, accrediting bodies, and third-party payers.

All other duties as assigned.

Requirements

• 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 the OASIS Certificate and Competency Board (OCCB).
• Current unencumbered license for the state of Ohio to practice as a Licensed Practical Nurse (LPN) preferred.
• Certification in ICD-10 diagnosis coding required or willingness to obtain within six months of hire.
• 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.
• Must be able to read, write, speak, and understand the English language.

Working Conditions

• 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