QA Specialist (PRE-ID) (10828)

Essential Job Functions/Responsibilities

• Possesses and maintains current CPR certification.
• Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications.
• Works with clinical staff to clarify data integrity issues and makes appropriate corrections per organization policy.
• Reviews OASIS assessments for appropriateness, completeness, and compliance with federal and state regulations and organization policy.
• Utilizes OASIS variation or alert reports when reviewing OASIS data.
• Ensures appropriate ICD-9 coding and sequencing as it relates to the patient's medical condition, including any co-morbidities.
• Participates in Quality Improvement and Corporate Compliance activities as assigned.
• Works with managers to address trends that affect the agency's outcome and process measures noted during OASIS review.
• Makes OASIS inter-rater reliability visits with clinical staff.
• Reviews visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and/or underutilization to the clinical manager/designee.
• Notifies organization leadership of problematic trends as a result of OASIS review.

Qualifications

• One (1) to two (2) years of clinical home health experience required.
• Working knowledge of OASIS and ICD-9 coding.
• OASIS certification (COS-C) preferred; OASIS Home Health ICD-9 coding certification preferred.
• Knowledge of federal regulations and state licensure requirements.
• Working knowledge of computer systems.
• Licensed driver with automobile that is in good working order and insured in accordance with organization requirements.
• Excellent coordination and communication skills.
• Detail oriented and able to work with minimal supervision.