PRN Registered Nurse RN ICD 10 and Oasis Reviewer

JOB PURPOSE\:

Under the supervision of the Director of Episode Assessment Coordination (DEAC), the Episode Assessment Coordinator (EAC) is responsible for prospective review of episode related documents, ensuring all services and documentation meet the organizations standards for service delivery that is appropriate, adequate, effective and efficient, and meets all state and federal guidelines. The EAC in prospective review also ensures service utilization meet needs for improved patient outcomes and appropriate claims reimbursement according to regulatory billing guidelines.

KEY RESPONSIBILITIES\:

1. Performs prospective review of Referrals, History and Physicals, Orders, medication profiles, homebound statements, interventions and goals and OASIS assessments to include\: Start of Care (SOC), Resumption of Care (ROC), Recertification (Recert), Transfer (TSF) and Discharge (D/C) to ensure appropriateness, completeness, accuracy and compliance with all state and federal regulatory and accreditation guidelines.

2. Ensures appropriate sequencing and ICD-10 coding on the Physician’s Plan of Care ( POC) as it relates to the patient’s medical conditions, including any co-morbidities and current guideline requirements and conventions,

3. Consults with the appropriate clinician to clarify any data integrity issues and/or corrections to documentation; documents same in the electronic medical record (EMR), Assists clinicians in establishing goals, setting priorities and in ensuring appropriate data elements are included in the (POC),

4. Reviews visit utilization for appropriateness as per care guidelines and, best practices and patient condition; reports potential financial losses and/or underutilization to the Clinical Manager or designee.

5. Stays informed about changes in the home health care industry, including state and federal regulations, accreditation requirements. Attends education sessions as assigned and shares that information with agency staff as appropriate,

6. Works closely with clinical consultants, compliance department and agencies as expertise required, identification of audit results/trends identified and works with agencies to educate and monitor staff improvement as necessary to improve audit outcomes,

7. Works closely with the agency Clinical Manager other office peers, to proactively address all service delivery documentation requirements for the most effective revenue cycle management possible, coordinates episode planning with the CM to assure accuracy of the HHRG scores upon admission and recertification,

8. Works closely with agency clinicians regarding timely acceptance or decline of recommended changes in the clinical record and locking the OASIS with company processes and/or escalates identified needs to achieve this to agency supervision and DEAC.

9. Follows workflow requirements in HCHB as identified by department approved processes\:

a. Field clinician “synchs” documentation following discussion with the Clinical Manager (CM) to establish patient history, need for interventions and services,

b. Once “synched” by the clinician, the CM reviews the initial documentation including but not limited to Face to Face (F2F) documents and requirements, does first review of the POC for completeness and accuracy after discussion with the field clinician, reviews OASIS items related to timely initiation of care, etc. and assists in any needs for orders, other disciplines, etc. If there are any identified changes at that time, the CM makes changes to be as proactive as possible,

c. Once the workflow task is completed by the CM it “flows” to the EAC for their final review of the POC locators, the OASIS items, the sequencing of the most appropriate diagnosis to the care episode and the assignment of the ICD-10 billing code,

d. The EAC reviews any additional evaluation documentation that has been received by other disciplines involved in the plan of care, and any coordination notes that exist on the patient at time of review and follow-up,

e. The EAC reviews all alerts (critical, reimbursement related and informational) in SHP and resolves each before finalizing the POC, and locking the episode,

f. Advises of any outstanding items that require further resolution and works with peers, agency operations staff and field clinicians to assist in having a clean month- end close for the office reviewed for.

10. Participates where possible in weekly Care Team Conference (CTC) meetings to continue to educate and monitor field clinicians with outstanding needs, and to ensure follow-up to outstanding reviews is completed,

11. Participates where possible in QAPI related activities with operations, to report specified trends and needs for continuous performance improvement,

12. Completes all required online training as identified with the department,

13. Works with the Director of the EAC department to ensure daily productivity review requirements are achieved and assists other EACs to ensure Operations support for timely review and billing.

14. May be assigned to work with Director as team leader for daily assignment configuration to achieve reviews in a timely manner.

15. Must be certified in ICD-10 coding by an accredited industry program upon hire, or show evidence of testing date within 60 days of hire. Must achieve certification upon testing or face termination.

16. Must achieve OASIS certification within first 9 months of employment or face termination.

17. Maintains ongoing ICD-10 certification and OASIS certification during employment.

KNOWLEDGE, SKILLS, ABILITIES\:

• Must be willing to pursue licensure in additional states of operations as requested to meet needs of the department,

• Excellent oral and written communication skills,

• Working proficiency in computers, electronic medical record systems – Home Care Home Based experience preferred,

• Excellent time management and organizational skills to complete daily work requirements,

• Ability to adapt to changing organizational and industry needs,

• Demonstrates ability to motivate, coach and educate others,

• Demonstrate excellent customer service skills,

• Detail oriented and able to work independently and with peer groups to meet deadlines,

• Remains flexible to assist other team members as requested or assigned in meeting the overall needs of the department and agency operations.

• In an extreme emergency – may be required to assist with agency operations/patient assistance during disaster situations