- Code diagnosis accurately utilizing ICD-10 for purposes of reimbursement and compliance within coding regulations and guidelines
- Identify problems and follow up as needed with appropriate staff and/or department for correction
- Review coding to ensure documentation is completed within Agency's admission timeframe
- Establishes and promotes ongoing communications with Agency personnel
- Charged with responding, managing, and monitoring payer Additional Documentation Requests (ADR) and communications. Works with branch staff to gather required information and submits timely response to ADR requests
- Monitors OASIS timing and collaborates with branch and billing staff to determine resolutions
- Audits patient records for quality and compliance per applicable home health regulations for submission for pre-claim review process of Review Choice Demonstration and/or Targeted Probe and Educate records
- Audits patient records for quality and compliance per applicable home health/hospice requirements or for other projects per agency need including but not limited to improvement plans as part of targeted probe and educate surveys, performance improvement programs and patient safety surveys
- Formulates and submits letters of appeal. Creates an effective appeal utilizing relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines, evidence-based medicine, local and national medical management standards, and protocols
- Performs ad hoc audits and reporting per request
- Analyzes information gathered by audits and reports and makes recommendations for changes to or development of policy/process and education
- Tracks audit result reporting results and shares with all interested stakeholders (., compliance, legal, clinical support, and local operations & clinical staff)
- Acts as a resource and has expert knowledge of Medicare, Medicaid, ICD-10 Coding and OASIS and other applicable regulatory requirements
- Provides consultation and education for clinical staff as needed to ensure accurate, timely, compliant documentation that drives accurate billing
- Clinical review positions will require a RN degree in nursing from an accredited or approved school
- Two years of experience in health care utilization review or home health care
- Clinical review will require a current license/registration by state of hire as a nurse
- Successfully completed HCS-D coding certification, required and to be maintained
- Successful achieve of OASIS certification, required to be maintained
- Expert written and verbal communication skills
- Strong presentation skills to various audiences
- Strong interpersonal skills
- A thorough knowledge of federal regulations and Medicare requirements is required along with analytical skills to interpret and apply regulatory requirements
- Extensive knowledge of Home Health or Hospice operations, compliance requirements
- Extensive experience in working with Payer requirements, ADR requests, Denials, Appeals, RAC/ZPIC responses
- Ability to prioritize tasks and manage multiple projects
- Strong analytical and problem-solving skills with attention to detail
- Ability to utilize a personal computer and other office equipment
- Proficient use of Electronic Medical Record software
- Proficient use of Microsoft Office Suite—Excel, Word, and PowerPoint
- Solid ability to learn new technologies and possess the technical aptitude required to understand flow for data through systems as well as system interaction
-
UofL Health Louisville, United States RegularOverview · The research billing coordinator position is responsible for reviewing the clinical research patient accounts in comparison to the clinical trial protocol, contracts, consent form and medical record to ensure that charges for items and services that are related to the ...
-
Coder II
2 weeks ago
Norton Healthcare Louisville, United States Full time· Responsibilities · The Coder II reviews, analyzes, and codes diagnostic and procedural information using ICD-10-CM diagnosis and procedures and CPT coding for reimbursement. Assign and sequence ICD-10-CM/CPT codes by applying regulatory coding guidelines. Apply advanced knowl ...
-
Coder I
2 weeks ago
Norton Healthcare Louisville, Kentucky, United States PermanentResponsibilities: · The Coder I reviews, analyzes and codes diagnostic and procedural information using ICD-10-CM diagnosis and procedures and CPT coding for reimbursement. Assign and sequence ICD-10-CM/CPT codes by applying regulatory coding guidelines. Apply advanced knowledge ...
-
RN Shift Coordinator, ED, 1p-1a
3 weeks ago
UofL Health Louisville, United States RegularJob Summary · The Shift Coordinator will provide support and will work collaboratively with the Clinical Manager and the Director. The Shift Coordinator will hold staff accountable on his/her shift and provide feedback to Clinical Manager. The Shift Coordinator is an extension o ...
-
Norton Healthcare Louisville, United States Full time· Responsibilities · Discover a medical assisting career designed with you in mind. At Norton Healthcare, you'll find an organization that values and supports your well-being while offering competitive pay, a wide range of benefits, tuition assistance and hiring programs. · Med ...
-
Norton Healthcare Louisville, United States Full time· Responsibilities · Discover a medical assisting career designed with you in mind. At Norton Healthcare, you'll find an organization that values and supports your well-being while offering competitive pay, a wide range of benefits, tuition assistance and hiring programs. · Med ...
-
Global Quality Manager
2 weeks ago
TalentBurst, an Inc 5000 company Louisville, United StatesDepartment/Group: Distribution Quality Chapter · Job title: Global Quality Manager · 12 months · Louisville, KY · Main Purpose of the Position · ● Provide quality and compliance oversight for Clinical and Commercial PT distribution and in-country GMP/GDP operations to ensure they ...
-
Patient Care Assistant, Ortho, 7p-7a
2 weeks ago
UofL Health Louisville, United States RegularJob Summary · The Clinical Assistant provides clinical patient care support in a caring, safe, and efficient manner, under the supervision and delegation of the Registered Nurse. In collaboration with patients and families (as defined by the patient) the Clinical Assistant is re ...
-
UofL Health Louisville, Kentucky, United States PermanentOverview: · Job Title: Clinical Staff Pharmacist Inpatient Pharmacy · We are Hiring at Jewish Hospital · Location: 200 Abraham Flexner Way Louisville KY 40202 · Shift Options: 9a-530p Every 4th weekend Rotation · The Clinical Staff Pharmacist provides comprehensive pharmaceutical ...
-
Mental Health
2 days ago
Crossover Health Louisville, United States Part timeAbout Crossover Health · Crossover Health is creating the future of health as it should be. A national, team-based medical group with a focus on wellbeing and prevention that extends beyond traditional sick care, the company delivers an entirely new model of healthcare—Primary H ...
-
Revenue Cycle Manager
5 days ago
Park Duvalle Community Health Louisville, United States Full time· Revenue Cycle Manager · We are seeking a dynamic and experienced Revenue Cycle Manager to oversee the financial operations of our community health center. The Revenue Cycle Manager will play a critical role in managing all aspects of the revenue cycle process, including billin ...
-
Global Quality Manager
2 weeks ago
Innova Solutions Louisville, United States ContractInnova Solutions is immediately hiring for a Global Quality Manager · Position type: Full time Contract. · Duration: 12 months · Location:Louisville, KY · As a Global Quality Manager , you will: · Job Description: · Main Purpose of the Position Provide quality and compliance ov ...
-
Adjunct Medical Coding Instructor
2 weeks ago
Sullivan University Louisville, United StatesLook No Further, Your Career Starts Here · Sullivan University is an organization that is truly committed to making a difference. We host a wide variety of career opportunities, offer a family-oriented culture, and invest in our employees. Join us if you want: Internal Mobility ...
-
Executive Business Professional
1 week ago
Seven Counties Services, Inc. Louisville, United States Full timeJob Description: · Under moderate supervision, receives all incoming calls from potential clients and assesses these calls for content, applicability to SCS programs, urgency, lethality, need for pharmaceutical intervention and financial payor source. · ESSENTIAL JOB FUNCTIONS ...
-
Covenant Health Louisville, United States Full timePosition Summary: · Provides administrative coverage for the patient service functions related to the check-out operations of the physician practice. Collects and processes encounter form data. Collects and totals outstanding balances and payments for services rendered. Balances ...
-
Housekeeping/Laundry Manager
3 weeks ago
Landmark of Iroquois Park Louisville, United States Full timeUnder the direction of the Administrator, the Director of Housekeeping is responsible for the daily operations of the housekeeping department, including staffing, supply ordering and supervision. The person holding this position is delegated the responsibility for carrying out th ...
-
Data Architect
4 days ago
PharmaCord Jeffersonville, United StatesOur Company: PharmaCord is a leading provider in pharmaceutical patient support services. Our services are sponsored by our pharmaceutical company clients. Together, we are committed to compassionately providing patients with support services during their journey on therapy. · We ...
-
Supervisor, Patient Services
5 days ago
PharmaCord Jeffersonville, United StatesOur Company: PharmaCord is a leading provider in pharmaceutical patient support services. Our services are sponsored by our pharmaceutical company clients. Together, we are committed to compassionately providing patients with support services during their journey on therapy. · We ...
-
Associate Director, Patient Services
5 days ago
PharmaCord Jeffersonville, United StatesOur Company: PharmaCord is a leading provider in pharmaceutical patient support services. Our services are sponsored by our pharmaceutical company clients. Together, we are committed to compassionately providing patients with support services during their journey on therapy. · We ...
-
Program Manager
5 days ago
PharmaCord Jeffersonville, United StatesOur Company: PharmaCord is a leading provider in pharmaceutical patient support services. Our services are sponsored by our pharmaceutical company clients. Together, we are committed to compassionately providing patients with support services during their journey on therapy. · We ...
Clinical Coding - Louisville, United States - BrightSpring Health Services
Description
Overview
The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit support required to ensure timely processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all payor types striving to improve clinical documentation and minimize lost revenue. Conducts analysis on timely submission of coding reviews and supports branches to prevent edit lock OASIS to be prior to the 30-day limit. Provide support and coordination with branches if re-coding records is required for sufficient billing practices to be met. This position will also support detailed level reporting and analytics, clinical appeals, root cause analysis, and address identified trends in reasons for denials related to coding and/or OASIS related documentation. Partners with Home Health operations and customers to drive improvement in the quality of services delivered to patients.
Responsibilities
Qualifications
About our Line of Business
BrightSpring Health Services is a leading provider of complementary home and community-based pharmacy and health services for complex populations in need of chronic and/or specialized care. Through the company's pharmacy and provider services to seniors and specialty (including behavioral) populations, we provide comprehensive care and clinical services in 50 states to over 360,000 customers, clients and patients daily. The company's services foster greater patient and family satisfaction, improve outcomes and reduce health care system costs, and are supported by industry-leading quality outcomes. For more information, visit . Follow us on , and .
