Clinical Packet Review Specialist (24592)

Cantex Continuing Care Network•Stafford, TX

3d•Hybrid

About The Position

The Clinical Packet Review Specialist is responsible for reviewing and validating home health clinical documentation to ensure accuracy, completeness, regulatory compliance, and consistency prior to billing and submission. This role focuses on comprehensive review of OASIS assessments, physician orders, and Plans of Care (POC/485) to support quality patient outcomes, Medicare compliance, and agency performance measures. The specialist collaborates with clinical staff, quality assurance, and leadership teams to identify documentation deficiencies, provide feedback, and facilitate timely corrections.

Requirements

Graduate of an accredited nursing program.
Current Registered Nurse (RN) license required.
Minimum 3 years of Home Health experience preferred.
Strong working knowledge of OASIS-E and Medicare home health regulations.
Experience with Plan of Care (485) review and physician order management.
Prior QA, clinical review, coding, or OASIS auditing experience preferred.
Advanced understanding of home health documentation requirements.
Strong knowledge of CMS regulations and reimbursement methodologies.
Excellent critical thinking and clinical assessment skills.
Ability to interpret physician orders, visit documentation, and patient records.
Strong written and verbal communication skills.
High attention to detail and organizational skills.
Proficiency with electronic medical record systems and Microsoft Office applications.

Nice To Haves

3 years of Home Health experience preferred.
Prior QA, clinical review, coding, or OASIS auditing experience preferred.
Other home health quality or compliance certifications

Responsibilities

Review Start of Care (SOC), Resumption of Care (ROC), Recertification, Transfer, Discharge, and other OASIS assessments for accuracy, completeness, and consistency.
Validate OASIS responses against clinical documentation and supporting records.
Identify documentation discrepancies that may impact reimbursement, quality outcomes, compliance, or Home Health Value-Based Purchasing (HHVBP) results.
Ensure assessments support homebound status and skilled need documentation.
Review Plans of Care (485s) for completeness, accuracy, and alignment with physician orders.
Verify that diagnoses, interventions, visit frequencies, goals, medications, and disciplines are appropriately documented.
Ensure physician orders accurately reflect the patient's clinical needs and treatment plan.
Confirm that documentation supports services ordered and delivered.
Serve as a resource for clinicians regarding OASIS and Plan of Care documentation standards.
Provide constructive feedback and education to field staff.
Work closely with Directors of Clinical Services, Administrator, and Quality Director to improve documentation accuracy and outcomes.