This is a part to full-time position.
Review all Medicare and other episodic payers’ clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.
Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines. Identifies clinical problem areas and documents deficiency trends in a proactive approach. Educates administrative and clinical associate staff in the correction of these deficiencies.
Assist with quality improvement and Medicare compliance training program. Identify trends of deficiencies with Medicare Conditions of Participation, clinical care, coordination of care, and documentation for the purposes of requiring more extensive education or action of clinical staff.
In accordance with the Clinical Director, monitor the receipt of Medicare denials, Billing Compliance held claims, and other payer denial notices. Assess the validity of these denials, and responds with additional information. Inform the Branch Director and Branch staff of noticeable trends or relevant issues.
In accordance with the Clinical Director, prepare and file general appeals on a timely basis. Attend fair hearings as necessary. Collaborate with the Clinical Leadership and clinical associate staff in resolving complex clinical issues.
Participate in the initial orientation of the clinical associate staff regarding Medicare Conditions of Participation and relevant requirements for care and documentation and provides education during the orientation in the timeliness of paperwork and flow of OASIS.
Collaborate with branch Clinical Leadership to analyze Performance Improvement trends in the delivery of care. Keep up with the performance indicators and monitors the Performance Improvement plan for the branch.
Job Type: Part-time
- Home Health and/or Hospice: 1 year
• Post ID: 17894842 utah