Job Information
BrightSpring Health Services Clinical Coding & Audit Specialist in LOUISVILLE, Kentucky
Our Company
BrightSpring Health Services
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
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 (e.g., 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
Qualifications
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
About our Line of Business
BrightSpring Health Services provides complementary and integrated home- and community-based pharmacy and health solutions for complex populations in need of specialized and/or chronic care. Through the Company’s service lines, including pharmacy, home health care and primary care, and rehabilitation and behavioral health, we provide comprehensive care and clinical solutions in all 50 states to over 400,000 customers, clients and patients daily. For more information, visitwww.brightspringhealth.com. Follow us on Facebook (https://www.facebook.com/brightspringHS/) , Twitter (https://www.twitter.com/BrightSpringHS/) and LinkedIn (https://www.linkedin.com/company/brightspringhealth/) .
ALERT: We are aware of a scam whereby imposters are posing as employees from our company. Beware of anyone requesting financial or personal information. We take pride in creating a best-in-class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card, driver’s license, bank information, or payment for work equipment, etc.) from you via text or email. If you are suspicious of a job posting or job-related email mentioning our company, please contact us at TalentAcquisition@brightspringhealth.com .
Click here (https://www.brightspringhealth.com/careers/frequently-asked-questions/) for additional FAQ information.
Job LocationsUS-KY-LOUISVILLE
ID 2024-149533
Line of Business BrightSpring Health Services
Position Type Full-Time