[Hiring] Review Specialist, OASIS & 485 @ResMed

Role Description

This is a remote position that provides flexibility and control over assigned workload. The OASIS Review Coding Specialist is responsible for performing 485 Review, OASIS Review, and coding duties while providing excellent service levels deserved by all MatrixCare customers. This role reports to the Supervisor of Coding and Review Operations or Manager of Coding and Review Services.

• Coding level exceeds (or at minimum perform at required productivity levels equivalent of 8 completed 485 review or 10 completed OASIS Reviews per day for FT employees).
• Extract clinical information from OASIS Assessment as well as a variety of medical records.
• Assign appropriate ICD-10 Code(s) based on medical records according to established procedures and coding guidelines.
• Suggest changes to OASIS responses based on documentation in the medical record according to established Oasis guidance.
• Recommend changes to the 485 locators based on clinical documentation and in accordance with COP’s.
• Works with external coding databases and industry accepted tools.
• Communicate with agencies effectively and provide excellent customer service.
• Work is completed and documented accurately and timely.
• Conducts peer audits as needed/assigned.
• Regularly provides feedback for processes and performance improvement.
• Quickly ascertain customer needs through research and communication and provide quality solutions.

Qualifications

• Graduate of accredited school of professional nursing and BSN preferred.
• 2 years of home health OASIS/485 review and coding experience.
• 5 years’ experience in home health and/or hospice preferred.
• A thorough education in EMR systems, coding regulations, PDGM and medical terminology with proven coding capabilities.
• Certification in home health coding (HCS-D or BCHH-C in ICD-10).
• Certification in OASIS (COS-C or HCS-O).
• Experience in quality assurance (QA) or case management a plus.
• Experienced in review of the 485 in line with industry and regulatory standards.
• Ability to communicate effectively with agency staff, management, and other members of the team.
• The ability to make clear, decisive clinical decisions.
• Must understand the impact of clinical decisions as it relates to agency operations and financial impact.
• Must have the ability to justify and at times, defend clinical decisions and documentation.
• Exceptional computer, software and typing skills.
• Must have the ability to work independently, with dynamic and changing priorities while meeting or exceeding targeted event quota.
• Skilled in dealing with a high volume of competing tasks in a fast-paced environment. Strong focus on problem-solving initiatives and quick resolution.
• Detail-oriented as proper billing and reimbursement depend on coding expertise.
• Must comprehend the basics of medicine, such as anatomy, physiology, diseases, and diagnoses.
• Organized, efficient and precise with strong communication and liaison skills, dependable and hard working with extensive background in quality customer support.
• Must comprehend the basics of home health and hospice business operations, insurance claims processes, and basic office procedures.

Benefits

• Comprehensive medical, vision, dental, and life insurance.
• AD&D, short-term and long-term disability insurance.
• Sleep care management.
• Health Savings Account (HSA).
• Flexible Spending Account (FSA).
• Commuter benefits.
• 401(k).
• Employee Stock Purchase Plan (ESPP).
• Employee Assistance Program (EAP).
• Tuition assistance.
• Employees accrue fifteen days Paid Time Off (PTO) in their first year of employment.
• Receive 11 paid holidays plus 3 floating days.
• Eligible for 14 weeks of primary caregiver or two weeks of secondary caregiver leave when welcoming new family members.