Clinical Documentation Specialist
About The Position
The Clinical Documentation Specialist - Utilization Review at HomeCare & Hospice is responsible for reviewing all clinical assessments (OASIS) and plans of care based on the client's needs and the agency's reimbursement. This role involves overseeing and evaluating services provided to home health clients to optimize clinical outcomes, financial profitability, and regulatory compliance. The specialist will collaborate with payors as needed, review the profit and loss of each client, and assess the client/caregiver's ability to support home care. Additionally, they will ensure proper ICD-10 coding, monitor client progress during home health admission, track care events that may alter care needs, manage an average caseload of 100-150 clients (1500 annually), and oversee the activity of 200 clinical staff.
Requirements
- Three to five years of clinical experience with at least two years of home care experience required.
- Basic computer skills required.
- Knowledge of Medicare regulations pertaining to Home Health.
- Current licensure in the Commonwealth of Pennsylvania as a Registered Nurse required.
Nice To Haves
- Knowledge of home health information system a plus.
- Expertise in Home Health Coding preferred.
- Home Care Coding Specialist - Diagnosis (HCS-D) Certification and Home Care Coding Specialist - OASIS (HCS-O) Certification preferred or will be obtained within 2 years of accepting the position.
- Bachelor's degree preferred.
Responsibilities
- Review all clinical assessment (OASIS) and plans of visit based on the care needs of the client and the reimbursement to be received by the agency for providing this care.
- Oversee and evaluate the services provided to home health clients to maximize clinical outcomes, financial profitability, and regulatory compliance.
- Make decisions in collaboration with the payor as needed by reviewing the profit and loss of each client taken under care and the ability of the client/caregiver to support care in the home.
- Ensure the proper ICD-10 coding.
- Oversee the progress of the client during the home health admission.
- Monitor care events that may trigger a change in care needs.
- Manage an average active caseload of 100-150 clients (1500 clients annually).
- Monitor the activity of 200 clinical staff.
Benefits
- Tuition Reimbursement (up to $6,000 per year based upon Full or Part Time status).
- Up to 240 hours of paid time off per year based on Full or Part Time status.
- Employee discounts to various activities, services, and vendors.
- Free employee parking.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
