Clinical Reviewer - Medical Coder & QA

Ohio Living; Westerville (OH); On-site; USD 64,000 - 90,000; Full time

Job summary

Ohio Living is seeking a Clinical Reviewer to lead documentation review for Home Health and Hospice services. You will ensure accuracy of OASIS, 485s, and planning of care, while coordinating with field staff and referrals to maintain quality patient care.

The role requires ICD-10 coding expertise, familiarity with Medicare guidelines, and proficiency in Windows/Microsoft Office. Previous OASIS experience is a plus.

Qualifications

• Must have ICD-10 coding experience and documentation accuracy.
• Experience with home health documentation and OASIS is a plus.

Responsibilities

• Process Home Health SOCs and Hospice Admission Plans of Care.
• Review 485s and OASIS-C for consistency with assessments.
• Code ICD-10 based on clinical documentation.
• Verify start of care dates and episode date ranges.
• Assist with ROC and discharge OASIS processes.
• Provide training and guidance on OASIS documentation.

Skills

ICD-10 coding

English language proficiency

Education

High school diploma or equivalent

Post‑secondary clinical education

COS-C OCCB certification

Ohio LPN license (preferred)

Tools

Windows

Microsoft Office (Word, Excel, PowerPoint)

Internet

Job description

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

Our intention is to haveemployees 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, streamliningprocesses, beingdependable,sparking creativity or something else,the demonstration ofHOW you do your job is just as important as WHAT you do in your job.

Alongsideour valued employees, we are making a difference throughout the state of Ohio in the lives of those that need healthcareorthoseembracingthe 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