Oasis Reviewer
About The Position
The OASIS Reviewer prospectively reviews OASIS assessments for accuracy, completeness, internal consistency, and compliance with federal and state regulations and agency policy. Working under the direction of the Coding and OASIS Manager and in collaboration with agency clinical teams, the reviewer serves as a quality checkpoint in the home health documentation process. The role supports data integrity, accurate clinical representation, compliant reimbursement, and quality outcomes. It also includes reviewing visit utilization, identifying and escalating potential clinical, financial, or compliance risks, participating in quality improvement and compliance initiatives, and maintaining current knowledge of OASIS standards and regulatory changes.
Requirements
- Working knowledge of the OASIS data set and assessment process.
- Strong understanding of federal regulations and state licensure requirements for home health.
- Knowledge of the legal and regulatory framework governing the home health industry.
- Ability to work independently while collaborating with interdisciplinary teams.
- Excellent written and verbal communication skills.
- Strong computer proficiency, including Microsoft Outlook and agency documentation systems.
- Valid driver’s license, vehicle insurance, and access to reliable transportation or public transportation.
- Strong attention to detail and focus on data integrity.
- Analytical thinking and issue identification skills.
- Ability to communicate clearly and professionally with clinical teams and influence documentation quality without direct authority.
- Strong organizational and time management skills.
- Commitment to quality improvement and compliance excellence.
Nice To Haves
- At least two years of home health clinical, coding, or billing experience.
- OASIS certification (COS-C).
Responsibilities
- Prospectively review OASIS assessments for appropriateness, completeness, and regulatory compliance.
- Evaluate OASIS data for internal consistency, accuracy, and alignment with the patient’s condition and care delivery.
- Use OASIS variation, validation, or alert reports to identify potential data integrity concerns.
- Ensure documentation supports accurate clinical representation and compliant reimbursement.
- Collaborate with clinicians and agency staff to clarify documentation discrepancies and data integrity issues.
- Guide clinicians on appropriate corrections in accordance with agency policy and regulatory standards.
- Support education and reinforce best practices for OASIS completion and assessment accuracy.
- Review visit utilization for alignment with patient condition, plan of care, and clinical guidelines.
- Identify and report potential underutilization, overutilization, or financial risk to the Coding and OASIS Manager, Clinical Manager, or designee.
- Escalate trends that may affect reimbursement, outcomes, or compliance.
- Identify and communicate problematic trends or recurring issues found through OASIS review.
- Participate in Quality Improvement and Corporate Compliance initiatives as assigned.
- Assist with additional chart audits or documentation reviews as needed.
- Maintain current knowledge of OASIS standards, regulatory changes, and industry best practices.
- Participate in ongoing education through workshops, training, and professional publications.
- Demonstrate and uphold CAPLICO values in interactions and work practices.
- Perform other duties and special projects as assigned.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
