Description

We are looking for a reliable and compassionate PCR Specialist PCR Special  for home health to join our team.

Why Lifecare Home Health Family?

Join our team at Life Care Home Health Family to be a part of a company that strives to provide the best care for our patients while building a team of dedicated employees. If you want a company that appreciates your skills, compassion, and heart, then Lifecare Home Health is the place for you! We take pride in not only providing excellent care to our patients but also creating a positive team environment with employee support.

We provide,

Benefits eligibility now starts the 1st of the month following employment.

• Competitive base Pay
• Medical, Dental, Vision
• 401 (K), Flex Spending
• Life Insurance
• Short- Long-Term Disability
• Mileage Reimbursement
• PTO
• Team Events
• Recruitment Incentive Program
• Continuing Education Training
• Employee Recognition Programs
• Performance Incentives
• Family Team Environment

General Summary: Under indirect supervision, audits medical charts and records for compliance with federal billing regulations and guidelines and Review Choice Demonstration project requirements. Uses knowledge of Review Choice Demonstration and billing guidelines and procedures to review all medical record chart criteria, ensuring that all elements of the record conform to legal and procedural requirements related to federal billing and Review Choice Demonstration guidelines. Reviews all records to achieve and maintain compliance with billing and Review Choice Demonstration requirements and compliance standards. Employees should be cross-trained in other home health roles to provide additional support as the need arises. This position will work closely with the RCO Compliance Coordinator.

Primary Duties and Responsibilities

• Audits medical record documentation to identify compliance with federal billing regulations and Review Choice Demonstration guidelines; prepares reports of findings and clearly communicates with clinical leadership to provide education and training on compliance issues.
• Provides oversight of the Review Choice Demonstration chart review process for assigned areas and proactively communicates with clinical leadership to ensure timely submission and provisional affirmation of all applicable records.
• Researches analyzes, and responds to inquiries regarding compliance, non-affirmations, denials, and billable services.
• Interacts with patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
• Trains, instructs, and/or provides technical support to patient care providers and clinical leadership as appropriate regarding billing compliance documentation, and regulatory provisions, and Review Choice Demonstration requirements in order to receive at a minimum 90% provisional affirmation rate.
• Uploads all pertinent documents and submits records in accordance with Review Choice Demonstration requirements to obtain provisional affirmation.
• Communicates closely with patient care providers, and clinical leadership r/t billing and Review Choice Demonstration requirements and results.
• Ensures strict confidentiality of clinical and financial records.
• Attend meetings, conferences, workshops, and in-house sessions to receive updated billing regulations and Review Choice Demonstration information and regulation changes.
• Performs miscellaneous job-related duties as assigned.
• Other Duties and Responsibilities as a Remote Support Specialist may include:
• Intake Responsibilities as needed
• Insurance Eligibility and Authorization coordination as needed
• Orders Management assistance as needed for multiple locations.

#LCHHLOW

Requirements

Minimum Job Requirements

• Licensed Professional Nurse or Licensed Vocational Nurse licensure preferred.
• At least three years of medical records auditing and review experience.
• Completed degree(s) from an accredited institution that is above the minimum education requirement may be substituted for experience on a case-for-case basis.

Knowledge, Skills, and Abilities Required

• Knowledge of auditing concepts and principles.
• Advanced knowledge of medical documentation and billing regulatory requirements.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to analyze and solve problems.
• Strong communication and interpersonal skills.
• Knowledge of legal, regulatory, and policy compliance issues related to medical documentation and billing procedures and documentation.
• Knowledge of current and developing issues and trends in medical documentation and regulatory requirements.
• Ability to clearly communicate medical information to professional clinicians.
• Detailed knowledge of Review Choice Demonstration guidelines and systems, medical documentation systems, procedures, and regulatory requirements.
• Ability to adapt and modify medical documentation review procedures, protocol, and data management systems to meet specific operating requirements related to billing and Review Choice Demonstration uploading and documentation requirements.
• Ability to provide guidance and training to professional and technical staff in their area of expertise.

Working Conditions and Physical Effort

• No or very limited physical effort is required.
• No or very limited exposure to physical risk.
• Work is normally performed in a typical interior/office work environment.

Machinery/Tools/Equipment Requirements:

• Reliable transportation and auto liability insurance.
• Computer and basic office equipment.

This description is a general statement of required essential functions performed regularly and continuously. It does not exclude other duties as assigned.