Medical Coder & QA, Clinical Reviewer

Ohio Living; United States; On-site; USD 65,000 - 85,000; Full time

Job summary

Ohio Living seeks a Clinical Reviewer to join our Home Health & Hospice team in Ohio. You will review patient information for starts of care, recertifications, ROC, and evaluations, ensuring quality documentation and coding accuracy.

Responsibilities include ICD-10 coding, validating care plans and dates, and assisting with staff training on OASIS and documentation per federal, state, and local regulations.

Qualifications

• COS-C certification required or willing to obtain within six months.
• Two years of medical-surgical, medical records management, or healthcare billing experience.
• Current unencumbered license for the state of Ohio to practice as an LPN is preferred.

Responsibilities

• Review and approve patient information for start of care, recertification, resumption of care, or evaluation visits.
• Code using ICD-10 according to guidelines and ensure accuracy of clinical data.
• Verify start of care, episode dates, and plan of care accuracy with field data.

Education

COS-C certification

LPN license (preferred)

Tools

Microsoft Office

Windows

Job description

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 Across our 11 life plan communities, we offer a range of options from independent living apartments and villas to specialized memory care and everything in between. Whether it's a helping hand or skilled nursing care, we're here to provide support at every stage of life's journey. But our commitment doesn't stop at our doorstep. Between Ohio Living Home Health & Hospice and Ohio Living Palliative Medicine, we extend our care to over 10 million Ohioans in the 43 counties we serve. We also offer provider-owned physician and nurse practitioner services, a Medicare Advantage plan, and pharmacy services - because health and wellness go hand in hand. The Ohio Living Foundation raises millions of dollars each year to support the people and programs of Ohio Living. From charity care to special programs and beyond, they're dedicated to making a difference in the lives of those we serve and ensuring that no one is left behind. At Ohio Living, our mission is that heart of all we do. For over 100 years, it has been our promise to care, to support, and to enrich the lives of our residents and communities.