Outcomes Specialist - RN/LPN - Remote Opportunity
JOB TITLE: Outcomes Specialist
**Remote position but will require attending regular on-site meetings.
Responsible for coding all claims using ICD-Codes including admission, resumption of care, and recertification. Ensure appropriateness of Plans of Care, and validate the thoroughness and accuracy of the OASIS by working closely with clinicians. Ensure quality and prevent over and underutilization.
- Must hold a current and valid clinical license (RN, LPN, SLP, OT, COTA, LPTA, etc). Prefer certification by the American Association of Professional Coders, Certificate for OASIS Specialist – Clinical or similar certifications.
- Knowledge of ICD-9 or 10 (Preferred) coding conventions, OASIS conventions, and be able to instruct and educate on these to a broad
- Advanced understanding of medical terminology and body systems/anatomy, physiology and concepts of disease.
- Must have at least one to two (1-2) years’ experience in home health or three (3) years’ experience in similar medical coding.
- Must be very detail oriented with understanding of federal and state guidelines for documentation and coding.
- Must be able to work cooperatively with other employees.
- Must be capable of performing the job functions of this position with or without accommodations.
ESSENTIAL JOB FUNCTIONS:
- Review OASIS data for quality and develop the correct coding diagnosis to create a clear picture of patient’s status at time of admission, resumption of care and recertification.
- Reviews discharge OASIS data to ensure appropriate outcomes have been achieved as compared to previous OASIS assessments.
- Work closely with the Performance Improvement Coordinator and/or Branch Manager to see that all home health referrals are accurately coded for reimbursement in a timely manner.
- Reviews clinical information for appropriateness, congruency and accuracy as it relates to the OASIS and 485, while using the Medicare PPS billing model and CMS guidelines.
- Ensure appropriate disciplines and number of visits are requested from physician, based on assessment.
- Report feedback to Agency Administrator/Branch Manager regarding their staff’s performance and educational needs and/or opportunities for improvement.
- Assist with employee orientation as it relates to required documentation and the admission and discharge process as requested.
- Provide education and act as a resource to field and office staff with regards to CMS guidelines, Home Care coding, PPS guidelines and billing related issues.
- Attend and participate in agency education and staff meetings.
- Assists in interpreting federal and state governmental regulations in regard to outcomes.
- Review of documentation for compliance with Medicare/Medicaid guidelines; necessity of services and compliance with physician’s orders.
- Adhere to all of the Company’s policies and procedures.
- Performs other duties as assigned.