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HC QA-coding Review Nurse

JOB SUMMARY:
The Quality Assurance and Coding Review Nurse in Home Care assist the PI Manager in ensuring excellent clinical outcomes and accurate HHRG Coding. This position also performs review of OASIS assessment and 485 for completeness and accuracy with coding based on ICD and CPT classification systems. Additionally, this individual will be responsible for abstraction of patient records according to coding requirements and procedures, utilizing SHP as a tool to review Coding and OASIS inaccuracies and make recommendations for changes.
RESPONSIBILITIES:
Reviews all admissions, discharges, and recertifications where appropriate.
Correctly codes diagnoses and procedures on all admissions using ICD-9(10) coding.
Compares chart documentation with Oasis documentation and ensures that coding and OASIS documentation is in compliance with all federal & state regulations.
Works with the Team Managers and PI Manager in conducting chart audits flagged for coding and OASIS accuracy issues.
Performs quality improvement measures and utilization review of medical records under the supervision of the PI Manager.
Serves as a back-up for authorization positions, Liaison Nurse and intake staff.
Functions as needed for all 3 locations and participates in quality improvement.
Audits medical records and provides reports based on coding and documents results as needed.
QUALIFICATIONS / REQUIREMENTS:
Experience: Coding, OASIS, and Home Health Prospective Payment System (PPS)
Education: Graduation from an accredited School of Nursing, BSN required.
Licenses / Certifications: Currently licensed as a registered nurse in the state of New York; Oasis certified (COS-C) within 5 months of hire; HCS-D
Other: Excellent understanding of coding OASIS and Home Health PPS
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