Episode Assessment Coordinator

At PruittHealth Home Health, we’re committed to a lot of things. But we’re especially committed to caring for our patients and residents, as well as providing our employees with a rewarding career as a member of our PruittHealth family. That’s why we attract employees who are passionate about providing the highest quality level of care possible for our patients. We also attract people who are looking for a home, rather than just a job – where being part of a family at work is as important as the type of work they are doing. As a member of our team, you will also have access a progressive benefits program that reflects our commitment to caring for our 16,000 partners. Position: Episode Assessment Coordinator (Home Health) full time and REMOTE Location: Any location throughout GA, NC or SC JOB PURPOSE: Under the supervision of the Director of Episode Assessment Coordination (DEAC), the Episode Assessment Coordinator (EAC) is responsible for prospective review of episode related documents. The EAC ensures all services and documentation meet both the organization's standards for appropriate, adequate, effective and efficient service delivery, and all state and federal guidelines. The EAC ensures service utilization meets needs for improved patient outcomes and appropriate claims reimbursement in accordance with regulatory billing guidelines. KEY RESPONSIBILITIES: Perform prospective review of referrals, history and physicals, orders, medication profiles, homebound statements, interventions and goals and OASIS assessments, including start of care (SOC), resumption of care (ROC), recertification (recert), transfer (TSF) and discharge (D/C). Ensure appropriateness, completeness, accuracy and compliance with all state and federal regulatory and accreditation guidelines. Ensure appropriate sequencing and ICD-10 coding on the physician’s plan of Care (POC) as it relates to the patient’s medical conditions, including any co-morbidities and current guideline requirements and conventions. Consult with the appropriate clinician to clarify any data integrity issues and/or corrections to documentation. Complete documentation using electronic medical records (EMR). Assist clinicians in establishing goals, setting priorities and in ensuring appropriate data elements are included in the POC. Review visit utilization for appropriateness as per care guidelines, best practices, and patient condition. Report potential financial losses and/or under-utilization to the clinical manager or designee. Stay informed about changes in the home health care industry, including state and federal regulations, accreditation requirements. Attend education sessions as assigned and shares that information with agency staff as appropriate. Work closely with corporate OASIS Reimbursement Coordinator (ORC) for any subject matter expertise required, identification of audit results/trends identified. Work with ORC to educate and monitor staff improvement as necessary to improve audit outcomes. Work closely with the agency clinical manager (CM) and other office peers to proactively address all service delivery documentation requirements, ensuring the most effective revenue cycle management possible. Coordinate episode planning with the CM to assure accuracy of the HHRG scores upon admission and recertification. Work closely with agency clinicians regarding timely acceptance or decline of recommended changes in the clinical record. As needed, lock the OASIS with company processes and/or escalate identified needs to agency supervision and DEAC. Follows workflow requirements in HomeCare HomeBase as identified by department approved processes. Participate where possible in weekly care team conference (CTC) meetings to continue to educate and monitor field clinicians with outstanding needs, and to ensure follow-up to outstanding reviews is completed. Participate where possible in QAPI related activities with operations, reporting specified trends and needs for continuous performance improvement. Work with the DEAC department to ensure daily productivity review requirements are achieved. Assist other EACs to ensure operations support for timely review and billing. May be assigned to work with DEAC as team leader for daily assignment configuration to achieve reviews in a timely manner. Must be certified in ICD-10 coding by an accredited industry program upon hire, or show evidence of testing date within 60 days of hire. Must achieve certification upon testing or face termination. Once received, maintain active certification during employment. Must achieve OASIS C-2 certification within first 9 months of employment or face termination. Once received, maintain active certification during employment. In an extreme emergency, may be required to assist with agency operations/patient assistance during disaster situations. MINIMUM EDUCATION REQUIRED: Nursing degree from an accredited college or university, or a graduate of an accredited/approved RN program. MINIMUM EXPERIENCE REQUIRED: Three (3) years' home health experience. In lieu of three years' home health experience, additional credentials will be considered. MINIMUM LICENSURE/CERTIFICATION REQUIRED: Current and unrestricted Registered Nurse (RN) licensure in state of practice. ADDITIONAL QUALIFICATIONS: (Preferred qualifications) Bachelor degree in nursing. Multi-state nursing RN licensure. Five (5) years’ experience in home health agency operations. Demonstrated knowledge of clinical record review processes, ICD-10 coding requirements and OASIS C2 conventions. Demonstrated knowledge of accreditation, federal regulations and state licensure requirements for home health service delivery. Demonstrated knowledge of federal interpretive guidelines and billing requirements for documentation for episodic and private insurance payers. Experience working in Home Care Home Base (HCHB) and Strategic Healthcare Partner (SHP) software applications. KNOWLEDGE, SKILLS, ABILITIES: Willingness to pursue licensure in additional states of operations as requested to meet needs of the department. Excellent oral and written communication skills. Working proficiency in computers and electronic medical record systems. Excellent time management and organizational skills. Ability to adapt to changing organizational and industry needs. Ability to motivate, coach and educate others. Excellent customer service skills. Detail oriented. Ability to work independently and with peer groups to meet deadlines. Flexibility and willingness to assist other team members as needed in meeting the overall needs of the department and agency operations. PruittHealth is an innovative, family-owned organization. We’re committed to providing exceptional care across a wide spectrum of services, including skilled nursing care, assisted and independent living, home health care, hospice care, rehabilitation, pharmacy and infusion services, and more. As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.