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Healthcare Coding and Compliance Analyst

2 months ago

Louisville, Kentucky, United States BrightSpring Health Services Full time


Position Overview:

As a vital member of the BrightSpring Health Services team, the Healthcare Coding and Compliance Analyst plays a crucial role in overseeing and executing the coding and compliance processes necessary for efficient management of patient care episodes. This position is responsible for ensuring that clinical documentation meets the required standards for reimbursement and compliance, while also striving to enhance the quality of documentation and reduce revenue loss.

Key Responsibilities:
  • Accurately code diagnoses using ICD-10 standards to ensure compliance with regulatory guidelines.
  • Identify and address discrepancies in documentation, collaborating with relevant staff to implement corrections.
  • Ensure that coding is completed within the designated admission timeframe set by the organization.
  • Foster ongoing communication with internal personnel to promote effective coding practices.
  • Manage and respond to payer Additional Documentation Requests (ADR), coordinating with branch staff to gather necessary information for timely submissions.
  • Monitor OASIS timing and work with billing staff to resolve any issues.
  • Conduct audits of patient records to ensure quality and compliance with home health regulations, particularly for pre-claim review processes.
  • Prepare and submit appeal letters, utilizing relevant clinical documentation to support claims.
  • Perform ad hoc audits and generate reports as requested.
  • Analyze audit findings and recommend improvements to policies and processes.
  • Track and communicate audit results to stakeholders, including compliance and clinical staff.
  • Serve as a resource with expertise in Medicare, Medicaid, ICD-10 coding, and OASIS requirements.
  • Provide education and consultation to clinical staff to ensure accurate and compliant documentation practices.
Qualifications:
  • Registered Nurse (RN) degree from an accredited institution.
  • Minimum of two years' experience in healthcare utilization review or home health services.
  • Current nursing license/registration in the state of employment.
  • Completion of HCS-D coding certification, with maintenance required.
  • Successful achievement of OASIS certification, with maintenance required.
  • Exceptional written and verbal communication skills.
  • Strong presentation abilities for diverse audiences.
  • Proficient interpersonal skills.
  • Thorough understanding of federal regulations and Medicare requirements, with strong analytical skills.
  • Extensive knowledge of home health or hospice operations and compliance standards.
  • Experience working with payer requirements, including ADR requests and appeals.
  • Ability to prioritize tasks and manage multiple projects effectively.
  • Strong analytical and problem-solving skills with meticulous attention to detail.
  • Proficient in using Electronic Medical Record software and Microsoft Office Suite.
  • Ability to learn new technologies and understand data flow within systems.
About BrightSpring Health Services:

BrightSpring Health Services is a premier provider of integrated home and community-based pharmacy and health services, dedicated to supporting complex populations requiring chronic and specialized care. Our comprehensive services are designed to enhance patient satisfaction, improve health outcomes, and reduce healthcare costs across the nation.