CODING/QUALITY REVIEW SPECIALIST - St. Claire Regional Medical Center

The Coding/Quality Review Specialist analyzes data integrity and consistency of OASIS documentation and assessment processes. This position will ensure appropriate ICD-10 coding and sequencing and work with clinical employees to clarify documentation and data integrity issues.

Duties/Responsibilities:
• Assigns ICD-10 CM codes to diagnoses from Outcome and Assessment Information Set (OASIS), record documentation, and care plans submitted.
• Initiates and does necessary follow-up with clients to obtain missing or incomplete information to code correctly.
• Reviews submitted OASIS documentation and IDC-10 coding and sequencing to ensure appropriate and required documentation on the OASIS as it relates to the patient’s status.
• Consults with the assessing clinician to clarify any OASIS or other documentation discrepancies and recommend appropriate corrections to the OASIS per this agency policy.
• Reviews submitted documentation to ensure clinical documentation meets CMS, Joint Commission, federal, and state regulations.
• Collaborates with Audit Specialist to clear charts for prompt and accurate billing.
• Maintains professional and technical knowledge in OASIS and ICD-10 Home Health Coding.
• Provides coding and OASIS education both onsite and virtually to clinicians.
• Assists in developing and maintaining competency evaluations for employees on OASIS.
• Takes referrals, physician orders, or critical labs.

Education:
Associate’s Degree in Nursing (ADN) required; Bachelor’s Degree in Nursing (BSN) preferred

Experience:
Experience in OASIS data collection required; One year homecare experience required; Additional performance improvement and Home Health Outcomes Quality Improvement experience preferred

Licensure/Certification:
Valid Kentucky Board of Nursing (KBN) license
Valid Kentucky Driver’s License
Home Care Clinical Specialist –OASIS (HCS-O) and Home Health coding certification required within twenty-four months of hire date

PI256056333