As a Medical Record Reviewer you will:

• Perform a thorough clinical record review to identify the documentation components required for PCR submission to the CMS MAC.
• Coordinate with branch back office and clinical staff regarding missing or incomplete documentation needed for PCR submission; includes monitoring for receipt of the requested documentation.
• Work with the RCD team to ensure timely and complete submission and/or resubmission of required documentation to the CMS MAC.
• Cross train as a billing auditor for Medicare and Insurance Audits; review clinical content for accurate claim filing.
• Maintain effective communication with field and office staff.
• Written communications are clear and concise.
• Comply with applicable legal requirements, standards, policies and procedures including but not limited to those within the Compliance Process, Code of Conduct and HIPAA requirements.
• Cooperate with monitoring and audit functions and investigations.
• Participate, as requested, in process improvement responsibilities.
• Meet expectations of quality and department goals as well as participate in quality improvement.
• Meet current objectives for growth and daily tasks while processing the required volume of work.
• Communicate effectively.
• Initiate continuing education opportunities and maintain the knowledge and skills required to perform the job.
• Meet Company attendance standards.
• Report to work at the assigned time and complete daily tasks at the assigned time.
• Comply with Company policies and procedures.
• Quickly and accurately identify the documentation components needed to meet the requirements for PCR submission. Including using critical thinking skills to identify issues with documentation that require escalation to an RN.
• Annotate documents for submission using software (Adobe Acrobat likely). May need to name files for submission.

Requirements of Qualified Candidates:

• Texas or Compact Nursing License required
• 1 – 3 years of experience in Medicare home health required
• Home health clinical record auditing experience preferred
• Firm working knowledge of concepts, practices and procedures of clinical documentation and ability to use in varied situations
• Strong computer/technical skills
• Ability to collaborate internally at all levels
• Must be proficient in Adobe Acrobat and Microsoft Office

Job Type: Full-time

Pay: $18.00 - $25.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person