Healthcare Professional

3 weeks ago

Washington, Washington, D.C., United States Prisma Health Full time

Job Summary:

This position provides coding and utilization analysis for Homecare patients and clinical staff. The ideal candidate will have strong analytical skills and attention to detail, with the ability to work collaboratively with QA OASIS-C reviewers to ensure month-end closing deadlines are met for coding and documentation review.

Key Responsibilities:

  • Provide coding and coding education to clinical and administrative staff of Home Health and Hospice.
  • Recognize when projected visits may result in over utilization of service and exceeds PPS reimbursement.
  • Work in collaboration with QA OASIS-C reviewers to ensure month-end closing deadlines are met for coding and documentation review.
  • Provide analysis and review of coding and compliance matters, to include research and interpretation of government regulations and payor billing requirements.
  • Keep department manager up to date on regulations and events that impact Homecare coding and utilization.
  • Maintain current working knowledge of PPS guidelines.
  • Assist with development of coding and billing procedures for new services.
  • Compile clinical staff utilization data and provide comprehensive and/or statistical reports to management as requested.
  • Accept assignments outside normal duties when such fulfills an agency need.

Requirements:

  • Graduate of an accredited school of Nursing program and approved by the South Carolina State Board of Nursing required.
  • At least 2 years' experience in home health. Must have experience working with ICD9 & training in ICD10 preferred.
  • Experience using utilization software such as PPS Plus is preferred.
  • Current South Carolina nursing license, current ICD9 certification, and ICD10 certification when enacted.
  • Must be computer literate. Must have experience with Microsoft applications (i.e. Word, Excel).

About Prisma Health:

Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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