We are seeking an experienced and detail-oriented Home Health Clinical Reviewer with expertise in ICD-10 coding, OASIS-E assessments, and Plan of Care (POC) reviews at Levels 2 and 3.
The ideal candidate will ensure clinical documentation accuracy, regulatory compliance, and optimal reimbursement through precise coding and thorough review of patient records.
This role plays a critical part in maintaining quality care standards while supporting operational efficiency in our home health program.
Key Responsibilities:1. ICD-10 Coding
· Assign accurate ICD-10-CM diagnosis codes for home health episodes in accordance with CMS and agency guidelines.
· Ensure coding supports medical necessity and aligns with the Plan of Care.
· Validate primary and secondary diagnoses for accuracy and compliance.
2. OASIS-E Review
· Review OASIS-E assessments for completeness, accuracy, and compliance with CMS guidelines.
· Identify and correct inconsistencies in assessment data and documentation.
· Provide feedback to clinicians to improve accuracy and quality of OASIS submissions.
3. Plan of Care (POC) Review – Level 2 & 3
· Review POCs for regulatory compliance, patient-centered goals, and accurate service frequency.
· Ensure care plans reflect patient needs, functional status, and physician orders.
· Collaborate with field clinicians to resolve discrepancies and clarify orders.
4. Quality & Compliance
· Maintain up-to-date knowledge of CMS regulations and PDGM requirements.
· Perform internal audits of documentation to ensure compliance and accuracy.
· Support clinical staff education on documentation and coding best practices.
Qualifications & Requirements:
· Minimum 2–3 years in home health coding, OASIS review, and POC preparation.
· Strong understanding of PDGM and CMS compliance requirements.
· Proficient in ICD-10-CM coding guidelines and sequencing rules.
· Expertise in OASIS-E data sets and scoring.
· Detail-oriented with strong analytical and problem-solving skills.
· Excellent communication and collaboration skills.
· Proficiency with EMR/EHR systems (e.g., Kinnser).
Job Type: Full-time
Pay: Up to ₹600,000.00 per year
Benefits:
- Work from home
Work Location: Remote
Expected Start Date: 01/09/2025
