Job Description
Are you a skilled clinician with a passion for ensuring accuracy and quality in home health care? We're seeking a dedicated and detail-oriented Clinical Review Specialist to join our remote team. This is a fantastic opportunity to leverage your clinical expertise and coding knowledge while working from the comfort of your own home.
What We Offer:
Fully Remote, Permanent Position: Enjoy the flexibility and convenience of working from anywhere.
Competitive Salary: Earn a base salary of $74,000 per year.
Performance-Based Bonus: Opportunity to earn up to $500 per quarter based on department metrics.
Comprehensive Benefits Package:
Paid holidays, vacation, and sick leave
Vision, dental, and medical health plans
Employer-paid life insurance
401(k) with company match
Direct deposit
Employee assistance program
Your Role:
As a Clinical Review Specialist, you'll play a crucial role in maintaining the integrity of clinical documentation and ensuring compliance with Medicare guidelines. Your responsibilities will include:
Clinical Information Review: Scrutinize clinical information for appropriateness, congruency, and accuracy, focusing on OASIS and ICD-10 coding within the Medicare PDGM billing model and CMS guidelines.
OASIS Edit Recommendations: Provide clear and constructive OASIS edit recommendations to clinicians to enhance accuracy.
OASIS Final Review and Locking: Perform meticulous final reviews and lock OASIS documents.
Timely OASIS Review and Coding: Maintain productivity at quarterly targets set by the Director of MCM.
Medicare Denial Prevention: Proactively prevent or reduce Medicare denials by ensuring accurate coding on plans of care and OASIS documentation.
Interdisciplinary Support: Offer support and clear communication to all disciplines within the service.
Customer Service and Education: Serve as a knowledgeable resource for Medicare Certified Offices, providing guidance on CMS guidelines, home care coding, PDGM guidelines, and billing-related issues.
Proactive Communication: Maintain regular communication with service offices via email, Zoom, or telephone, tailored to their specific needs.
Trend Analysis and Reporting: Communicate monthly and as needed with service offices, focusing on documentation trends, star ratings, and potential revenue impact.
Additional Duties: Perform related duties as required or requested by the Manager/Director.
What You'll Bring:
Clinical Expertise: Active State RN Nursing License, Physical (PT), Occupational (OT), or Speech (SLP) Therapist license with required certifications and a minimum of 2 years of clinical experience.
Technical Proficiency: Competency in PC skills necessary to perform job functions.
OASIS Certification: Required COS-C, HCS-O, or COQS OASIS Certification and experience.
Home Health Coding Certification: Required BCHH-C or HCS-D Home Health Care Coding Certification and experience.
Software Proficiency (Preferred): Experience with HCHB, SHP, and Coding Center is a plus.
Detail-Oriented: A strong commitment to accuracy and thoroughness.
Excellent Communication: Ability to communicate effectively with clinicians and administrative staff.
Problem-Solving Skills: Capacity to identify and resolve coding and documentation issues.
Join Our Caring Team:
Become part of a team dedicated to providing high-quality care and fostering professional growth. If you're a qualified clinician with a passion for accuracy and compliance, we encourage you to apply.
Equal Opportunity Employer:
We are an Equal Opportunity Employer and strongly encourage applications from all qualified individuals, including those from marginalized communities. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability.
Employment Type: Full-Time
Salary: $ 74,000.00 Per Year
Job Tags
Holiday work, Permanent employment, Full time,