Review Specialist, OASIS & 485

This is a remote position that provides flexibility and control over assigned workload. The role reports to the Supervisor of Coding and Review Operations or Manager of Coding and Review Services.

Responsibilities

• Perform coding duties exceeding or meeting required productivity levels (equivalent of 8 completed 485 reviews or 10 completed OASIS Reviews per day for full-time employees).
• Extract clinical information from OASIS Assessment and a variety of medical records.
• Assign appropriate ICD-10 Code(s) based on medical records according to established procedures and coding guidelines.
• Suggest changes to OASIS responses based on documentation in the medical record according to established OASIS guidance.
• Recommend changes to the 485 locators based on clinical documentation and in accordance with Conditions of Participation (COP’s).
• Work with external coding databases and industry-accepted tools.
• Communicate effectively with agencies and provide excellent customer service.
• Complete and document work accurately and timely.
• Conduct peer audits as needed or assigned.
• Regularly provide feedback for processes and performance improvement.
• Quickly ascertain customer needs through research and communication and provide quality solutions.

Requirements

• Graduate of an accredited school of professional nursing; BSN preferred.
• 2 years of home health OASIS/485 review and coding experience.
• 5 years’ experience in home health and/or hospice preferred.
• Thorough education in EMR systems, coding regulations, PDGM, and medical terminology with proven coding capabilities.
• Certification in home health coding (HCS-D or BCHH-C in ICD-10).
• Certification in OASIS (COS-C or HCS-O).
• Experience in quality assurance (QA) or case management a plus.
• Experience in review of the 485 in line with industry and regulatory standards.
• Ability to communicate effectively with agency staff, management, and other team members.
• Ability to make clear, decisive clinical decisions.
• Understand the impact of clinical decisions as they relate to agency operations and financial impact.
• Ability to justify and, at times, defend clinical decisions and documentation.
• Exceptional computer, software, and typing skills.
• Ability to work independently with dynamic and changing priorities while meeting or exceeding targeted event quotas.
• Skilled in dealing with a high volume of competing tasks in a fast-paced environment.
• Strong focus on problem-solving initiatives and quick resolution.
• Detail-oriented, as proper billing and reimbursement depend on coding expertise.
• Comprehend the basics of medicine, such as anatomy, physiology, diseases, and diagnoses to accurately translate medical jargon into code.
• Organized, efficient, and precise with strong communication and liaison skills.
• Dependable and hardworking with an extensive background in quality customer support.
• Comprehend the basics of home health and hospice business operations, insurance claims processes, and basic office procedures.

Benefits

• Comprehensive medical, vision, dental, and life insurance.
• AD&D, short-term and long-term disability insurance.
• Sleep care management.
• Health Savings Account (HSA) and Flexible Spending Account (FSA).
• Commuter benefits.
• 401(k) retirement plan.
• Employee Stock Purchase Plan (ESPP).
• Employee Assistance Program (EAP).
• Tuition assistance.
• Fifteen days of Paid Time Off (PTO) accrued in the first year of employment.
• 11 paid holidays plus 3 floating days.
• 14 weeks of primary caregiver leave or 2 weeks of secondary caregiver leave when welcoming new family members.

Pay

Base pay range for this position: $62,000.00 - $80,000.00. For remote positions located outside of the US, pay will be determined based on the candidate’s geographic work location, relevant qualifications, work experience, and skills.