Medical Coder & QA, Clinical Reviewer

Ohio Living•Lincoln, NE

About The Position

The Clinical Reviewer reviews and approves patient information provided by licensed professionals during start-of-care, recertification, resumption-of-care, and evaluation visits. The role supports quality patient care and stable relationships with referral sources, patients, caregivers, and staff, and assists with training agency staff in accordance with company standards and applicable federal, state, and local requirements. The Clinical Reviewer processes Home Health starts of care and Hospice admission plans of care, reviews clinical and assessment documentation, completes ICD-10 coding, processes OASIS information, and verifies that plans of care and service utilization align with patient assessments and medical conditions. The role also supports clinical staff with documentation and coding questions, orientation, and additional training needs. The position maintains accurate records and current knowledge of regulatory, accrediting, and third-party payer requirements. Work involves sitting up to eight hours per day, standing and walking up to two hours per day, and lifting, pushing, pulling, or moving equipment and supplies weighing up to 25 pounds. The role is classified as exposure risk category III for bloodborne diseases.

Requirements

High school diploma or equivalent.
Two years of post-secondary education in a clinical specialist or medical records program, or a Certificate for OASIS Specialist-Clinical (COS-C) designation from the OASIS Certificate and Competency Board (OCCB).
Certification in ICD-10 diagnosis coding, or willingness to obtain it within six months of hire.
Two years of medical-surgical, medical records management, or healthcare billing experience.
Experience with ICD-10 medical coding.
Proficiency with Windows, Microsoft Office (Word, Excel, and PowerPoint), and the internet.
Ability to read, write, speak, and understand English.

Nice To Haves

Current unencumbered Ohio license to practice as a Licensed Practical Nurse (LPN).
Experience in a Medicare-certified home health agency.

Responsibilities

Process Home Health starts of care and Hospice admission plans of care in a timely manner with assigned offices.
Maintain accepted productivity for plans of care and assist other Clinical Reviewers in meeting completion and provider-approval benchmarks.
Review evaluation packets, OASIS-C, 485s, and other Home Health and Hospice clinical information for consistency with the comprehensive assessment and plan of care.
Review field staff-submitted data for accuracy and follow up on documentation requiring correction.
Complete ICD-10 coding based on clinical documentation and applicable company and regulatory standards.
Ensure service utilization correlates with assessment data.
Process OASIS information and verify the correct start-of-care date and episode date range.
Process unlisted supplies, medications, activity, functional limitations, allergies, and other items appearing on the action screen to complete the 485.
Ensure appropriate care types and plans of care are selected based on the patient’s medical condition and staff assessment data.
Review resumption-of-care and discharge assessment data for accuracy and follow up on documentation requiring correction.
Process resumption-of-care and discharge OASIS information.
Ensure plans of care are completed and reassessed by the appropriate healthcare professional after significant changes in health status, at a physician’s request, and after hospital discharge; ensure appropriate documentation for patients transferred to an inpatient facility.
Assist clinical management staff with OASIS and documentation portions of job-specific orientation and provide additional OASIS documentation training as needed.
Keep clinical management staff informed of additional staff training needs.
Serve as a clinical resource to Home Health Clinical Supervisors and clinical teams on coding and clinical documentation.
Evaluate and process add-on visits to starts of care and resumptions of care.
Process Hospice starts of care and the Hospice Item Set to prepare required information for billing.
Participate in orientation of newly hired Clinical Reviewers as requested.
Maintain current and accurate records using computers and/or other documentation in accordance with company and regulatory requirements.
Maintain knowledge of requirements of regulatory agencies, accrediting bodies, and third-party payers.
Perform other duties as assigned.