HH Oasis Specialist
Ashland-KY-41101-United States
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JOB SUMMARY
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The Home Health Nurse Auditor Charge Capture and OASIS Nurse Specialist is responsible for prospective review of all coding of ICD10-CM scoring from the OASIS assessments and reviews OASIS data collection to ensure all services and documentation meet the organizations and accreditation standards and state and federal guidelines. This individual is responsible for optimal and quality charge entry related to all home health patients’ billable services. He or she will conduct thorough reviews of the medical record to ensure that the clinical documentation supports the capture and billing of charges. Takes an active role in identifying the discrepancies in the provider documentation and will report findings to management for educational purposes.
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DUTIES AND ESSENTIAL FUNCTIONS
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Overall performance rating of below indicated essential job duties:
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Reviews Oasis
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Working knowledge of CMS Condition of Participation in Home Health Services is required.
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Follow procedures to work within the frame of the law.
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Utilizes SHP alerts and validation reports in review of OASIS data.
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Consults with the appropriate clinician to clarify any data integrity issues and/or corrections to documentation; documents same in the medical record and makes necessary corrections to the collected medical information record. This may involve contacting the field RN/PT/OT/ST via telephone or electronic media to gain understanding of diagnostic assessment details.
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Assists clinicians in establishing immediate and long-term therapeutic goals, in setting priorities and in developing the plan of care.
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Reviews visit utilization for appropriateness as per care guidelines and patient condition; reports potential financial losses and/or under-utilization to the Clinical Supervisor/designee.
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Notifies agency leadership of problematic trends in OASIS documentation as a result of Oasis review.
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Stays informed about changes in the field of home health care, including state and federal regulations.
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Works closely with clinical manager to address trends that affect the agency’s outcome measures through OASIS review.
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Will assist with other chart audit activities.
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Monitors open and closed charts, and may participate in the quarterly clinical record reviews
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Assists quality improvement teams with data collection for the Quality Improvement Plan established by the Agency
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Respects confidentiality of information in the client clinical record and only shares this information in accordance with KDMC policy and HIPAA
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Is able to identify previous diagnoses/procedures that no longer apply to the current encounter.
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Is able to identify signs and symptoms of disease processes to discern when and when not to code signs and symptoms in addition to the main disease.
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Is proficient in selecting the principal diagnosis in cases where the principal diagnosis is not easily discernable due to the presence of multiple problems and follows current official coding guidelines to correctly assign choice of principal diagnosis.
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Does not maximize reimbursement through fraudulent practices involving the assignment of codes that do not conform to established and approved coding guidelines.
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Keeps leadership apprised of any problems or potential problems.
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Is able to identify all significant diagnoses and procedures that affect the encounter.
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Is able to assess the medical record documentation to assure that it provides the supporting documentation for each and every diagnostic or procedural coded assigned.
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Required to query/consult with the appropriate provider for clarification of data that is conflicting, ambiguous or requires more specific and detailed information in order for the correct code to be applied.
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Is required to follow correct query writing guidelines as set forth by compliance policy.
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Is required to know and follow KDMC's Corporate Compliance Policy.
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EDUCATION/LICENSE/CERTIFICATION/OTHER REQUIREMENTS
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Minimum requirement:
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Graduate of an accredited school of professional nursing.
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Maintains active licensure as a Registered Nurse in the states of Kentucky and Ohio.
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Maintains American Heart Association Basic Life Support
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Minimum of three years nursing experience in a home health setting.
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Must obtain Oasis certification within 1 year of start in position.
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Demonstrates organizational and leadership ability.
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Demonstrates a working knowledge of federal and state home care regulations including Medicare.
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Must have good verbal and written communication skills and evaluation techniques and demonstrate knowledge of clinical skills, judgment, current nursing practices and analytical capabilities.
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Knowledge of reimbursement sources and documentation requirements within home health care.
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Working knowledge of computer systems.
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Excellent time management and organizational skills
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Ability to adapt to changing organizational needs.
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Demonstrated ability to motivate and educate others.
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Excellent customer service skills.
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Detail oriented and able to work independently to meet deadlines.
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Highly organized
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Demonstrates excellent communication and interpersonal skills
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Preferred qualifications:
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Bachelor's Degree in Nursing
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WORKING ENVIRONMENT
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Works indoors in an office/clinic setting
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The noise level is usually moderate
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PHYSICAL DEMANDS
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Constantly required to maintain a stationary position behind a computer.
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Frequently required to move about inside the department.
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Constantly required to communicate telephonically and face to face with colleagues and customers.
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Constantly required to operate a computer and telephone.
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Constantly required to lift and/or move up to 10 pounds.
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Frequently required to lift and/or move up to 25 pounds.
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Occasionally required to lift and/or move up to 50 pounds
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Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, and depth perception
PI274664957
