GENERAL PURPOSE:
Accurate and timely coding and review of home health OASIS assessments and plan of care to ensure compliance with CMS regulatory guidelines, optimize reimbursement, contribute to overall quality improvement efforts, and manage visit utilization.
ESSENTIAL FUNCTIONS:
• Review and analyze OASIS assessments completed by clinicians to ensure accuracy, completeness, and compliance with regulatory requirements.
• Assign appropriate ICD-10 diagnosis codes based on referral paperwork and OASIS assessment data.
• Conduct face-to-face documentation review to ensure documentation supports the medical necessity of home health services and meets CMS requirements.
• Collaborate with interdisciplinary teams including nurses, therapists, and physicians to resolve discrepancies and ensure comprehensive documentation.
• Stay updated with changes in coding guidelines, regulations, and industry best practices related to home health care coding and reimbursement.
• Provide training and education to clinical staff on OASIS documentation requirements, Value Based Performance, and quality improvement initiatives.
• Maintain confidentiality and integrity of patient health information in accordance with HIPAA regulations and organizational policies.
• Review and assess the plan of care to ensure alignment with OASIS assessments, coding guidelines, and regulatory requirements.
• Demonstrate knowledge and experience with pre-claim review processes to support accurate and compliant claims submission.
• Manage visit utilization by reviewing visit frequencies, durations, and documentation to ensure appropriateness and compliance with payer guidelines.
• Any other duties as assigned.
QUALIFICATIONS:• Certification as a Home Health Coding Specialist (HCS-D)
• Certification as OASIS Specialist (COS-C) or Homecare Clinical Specialist – OASIS (HCS-O).
• Minimum of 2-3 years of experience in home health care coding and OASIS review.
ADDITIONAL REQUIREMENTS:
• Extensive knowledge in CMS guidelines/regulations, Value Based Purchasing, and Pre-Claim Review.
• Experience performing OASIS reviews using Homecare Homebase (HCHB).
• Excellent analytical skills and attention to detail to accurately abstract and assign ICD-10 codes from complex clinical documentation.
• Strong communication and interpersonal skills to collaborate effectively with multidisciplinary teams and physicians.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Work is completed and documented accurately and timely with high quality.
• Regularly provides feedback for process improvement.
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