Quality Assurance Nurse RN

5 days ago

Washington, Washington, D.C., United States Pinnacle Home Care Inc. Full time
Live Quality Assurance Specialist

Pinnacle Home Care Inc. is seeking a highly skilled and experienced Quality Assurance Specialist to join our team. As a Quality Assurance Specialist, you will play a critical role in ensuring the accuracy and quality of our coding and clinical documentation.


Key Responsibilities:
  • Perform centralized coding for Pinnacle Home Care agencies via scanned medical records and clinician documentation via EMR data.
  • Provide Home Health coding, OASIS, POC and quality review for assigned agencies.
  • Review records, recommending changes for clinician review and acceptance, based on CMS regulation, industry standards and coding convention as supported by documentation.
  • Review plan of care for accuracy and quality and make needed recommendations.
  • Apply knowledge of medical terminology, disease processes, and pharmacology.
  • Assess/review assessments for coding accuracy based on documentation, CMS regulations and coding conventions, OASIS compliance and Plan of Care quality and accuracy.
  • Maintain minimal productivity number standards daily.
  • Codes all assessments using ICD-10-CM (SHP, and Decision Health Coding Pro software) as well as appropriate industry references.
  • Consults Senior Director and works out difficult codes and/or coding problems as needed.
  • Attend/participate in continuous learning and education in ICD-10 coding, OASIS, Quality and Plan of Care development as necessary. Keeps abreast of regulatory changes and communicates these changes to Senior Director, Coding.
  • Meet or exceed minimum auditing and productivity scores for coding quality and compliance. Maintain quality of coding review with a score of 90% or greater on monthly and/or quarterly quality audits.
  • Plan, prioritize, organize and complete work to meet established objectives.
  • Should be good steward of all company financial resources, including but not limited to arrangements for equipment and other necessary items and services needed.
  • Performs duties in accordance of, and under the direction/supervision, as defined by the company organizational chart.
  • Assists on a variety of special projects and other duties as needed.
  • Follows agency policies and procedures. Maintains confidentiality of patients and agency information per HIPPA requirements.
  • Completes and submits all documentation in a timely manner according to department policy.
  • Attends in-service and education as required.
  • Adheres to Federal/State guidelines rules regulations, statutes and law.
  • Follows the Code of Conduct policy.
  • Complies with corporate and departmental policies and procedures.

Requirements:
  • Formal clinical background required, RN required, with current state nursing licensure.
  • Nationally accredited Coding ICD-10 certification required.
  • Nationally accredited OASIS- certification required.
  • Valid driver's license and auto insurance
  • Must complete required departmental competencies to validate and maintain competency.
  • Computer Skills:
  • To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software.
  • Must be proficient in the use of a PC, web-based portals and Microsoft Office Suite (Access, Excel, Outlook, Power Point and Word).
  • Knowledge of SHP and/or Decision Health Coding Pro is a plus.

The Company reserves the right to modify, add or change duties of the position at any time.


Education/Experience Education:


Associates degree or greater in a clinical program required with formal clinical background required, RN license required.


Experience:

  • Minimum of three (3) years on-going coding and abstracting experience in ICD-10-CM for Home Health agencies preferred.
  • Clinical home health experience preferred.
  • Experience with OASIS analysis preferred.

JOB ACCEPTANCE STATEMENT


I have reviewed these job requirements and verify I can perform the minimum requirements and essential functions of this position. I have read, understand and agree to the terms specified in the job description for the above-named position. A copy of this job description has been given to me. I further understand that this job description may be reviewed at any time and that I will be provided with a revised copy.


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