Home Health Coder/QA Specialist

Summary/Objective

Under the guidance of the VP of Quality, Compliance and Risk, the Home Health Coder-QA Specialist provides guidance to other members of the clinical team on overall quality and completeness of clinical documentation. 

• The Home Health Coder-QA Specialist is responsible for assigning ICD 10 diagnoses codes to ensure accuracy and completeness.
• Effectively collaborates from the back office and in the field with agency clinical leadership and clinicians to support accurate collection of patient assessment information for the Oasis. 
• Promotes excellence in patient care by focusing on patient practice and accurate clinical Plan of Care/Order completion. 
• Ensures accurate coding and Oasis scoring according to regulatory guidelines.
• Monitors and participates in clinical record review process for quality metrics and billing. 
• Conducts quality reviews to validate coding and PDGM group assignments to ensure compliance with Coding Guidelines as assigned.
• Leads training sessions on current billing, process/outcome measures results and coding information in conjunction with CDI Specialist and Staff Development as assigned.
• Provides mentoring and education to clinicians and clinical leadership to improve their current performance in all related areas.

Hours and Location: Remote- Per Diem and a 24-hour part time.

Required Education and Experience

• Bachelor’s degree or equivalent combination of formal education and experience.
• ICD-10 Certification credentials (HCS-D and/or HCS-H) required.
• Active clinical license in nursing, physical or occupational therapy in any of the states in which Tufts Medicine Care at Home providers practice.
• Oasis certification required.
• At least two years of experience in home health coding required; experience in education/mentoring/training preferred.
• Good command of concepts of human anatomy, physiology and pathology.
• Good organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work with accuracy and attention to detail
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions, adapt to changes in workload, and work schedule and to respond quickly to urgent requests.
• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
• Maintains professional skills and knowledge of coding through attendance at in-service programs, conferences, workshops and other educational programs and by review of current literature.
• Shares knowledge and learning experiences to staff.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.