Ohio Living · 5 hours ago
Coding & QA - Clinical Review
Ohio Living Corporate Office
Full-time
Onsite
Entry, Mid Level
2+ years expOhio Living is a healthcare organization focused on providing quality care and support to individuals in Ohio. The Clinical Reviewer is responsible for reviewing and approving patient information during various care processes, ensuring compliance with standards, and assisting in staff training to uphold quality patient care.
Health CareHome Health CareHospitalNon Profit
Responsibilities
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
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
Qualification
Required
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) required
Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) required
Certification in ICD-10 diagnosis coding required or willing to obtain within six months of hire
Two years of medical-surgical, medical records management, or healthcare billing experience required
Experience with ICD-10 medical coding required
Proficiency with Windows, Microsoft Office (Word, Excel, PowerPoint), and the internet required
Must be able to read, write, speak, and understand the English language
Preferred
Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred
Experience in a Medicare-certified home health agency preferred
Company
Ohio Living
Ohio Living is a nonprofit organization that expertise in-home health care, hospice, palliative care and physician services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Laurence Gumina
President & Chief Executive Officer
Leslie Belfance
Chief Operating Officer
Company data provided by crunchbase