Description

Position Summary: 

Responsible for ensuring accurate coding for all diagnoses and procedures utilizing the most current versions of the coding manual and guidelines. Reviews EMR data and makes recommendations for billing and statistical purposes. Oversees coding compliance initiatives, Case Mix Index Management and quality assurance/performance improvement activities.

Essential Duties & Responsibilities:

• Codes and sequences all diagnosis and procedures using established coding rules and current guidelines for accurate code assignment of each episode for care for home care billing.
• Responsible for monitoring and managing core measurements pertinent to the department to assure compliance with the operating plan.
• Coordinates the utilization and maintenance of multiple data bases to access needed information to ensure accurate coding.
• Assists with organization and participates in continuing education programs, seminars and workshops to keep abreast of documentation and coding changes. 
• Disseminates to appropriate management personnel, articles, white pages and educational updates as it relates to home health operations, coding and OASIS data collection.
• Maintains open lines of communication with clinical/billing staff to ensure accurate coordination of patient information and resolution of coding issues.
• Utilizes the most recent coding references and seeks clarification from the expertise of home care coding experts to ensure compliance when performing coding.
• Has understanding of each major payer’s coding/billing criteria, i.e. modifiers, V codes, etc.
• Stays current on all Medicare and CMS updates with regard to coding.
• Develops and conducts in-services with appropriate staff to keep current in procedures, updates to coding, OASIS data collection and other regulatory requirements.
• Ensures appropriate staff is trained in the use and function of coding applications and OASIS strategies. 
• Reviews and analyzes certain OASIS components such as technical compliance and provides feedback/education to clinical staff.
• Evaluates all software and system enhancements associated with coding functions. 
• Provides coding/OASIS orientation to new employees. Develops and conducts training to keep appropriate staff current in coding guidelines, regulations, and other requirements. 
• Serves as a resource/mentor for all coding functions with Peoples Home Health.
• Participates in accreditation program and all internal/external audits.
• Coordinates and manages QA/PI activities, including clinical record review activities as required by Agency.
• Assists Director of Nursing/Executive Director in the maintenance of agency manuals and reference materials for staff.
• Maintains an understanding of the company’s scope of services.
• Maintains a professional image.
• Uses appropriate phone etiquette. Understands the infrastructure of Peoples Home Health to appropriately transfer calls within the agency
• Promotes a customer friendly atmosphere for all visitors and ensures patient confidentiality at all times. 
• Performs other duties as assigned.

Requirements

Skills:

Self-Starter – Takes initiative identifies needs of co-workers and customers and solves problems.

Reading Comprehension – Understanding written sentences and paragraphs in work related documents.

Time Management – Managing one’s own time

Speaking – Talking to others to convey information effectively.

Writing – Communicating effectively in writing as appropriate for the needs of the audience.

Critical Thinking – using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems. 

Able to perform the essential functions of the job with or without accommodation. 

Education/Experience:

• Graduate of an accredited RN program, 
• Minimum three years nursing experience
• Home Health experience
• Expertise in OASIS assessments and PPS guidelines required. 
• Management experience. 
• Utilization Review/Case Management experience preferred.

Licenses, Certifications and/or Registrations:

• Current RN license in the State of Florida.
• Current HCS-D and HCS-O certification required.

Working Conditions:

Office Environment. May be exposed to biological hazards.