[Remote] HH Clinical Record Auditor

🌍 Remote, USA 💹 Full-time 🕐 Posted Recently

Job Description

Note: The job is a remote job and is open to candidates in USA. BrightSpring Health Services is a provider of home- and community-based health solutions. The Clinical Record Auditor conducts assessments of home health clinical records to ensure compliance with documentation requirements, informs leadership of results, and identifies trends for performance improvement.

Performs clinical record reviews to ensure compliance with coverage requirements, physician’s orders, care delivery standards, company policy, regulatory requirements, and accreditation standards
Keeps abreast of all company policies/procedures; local/state/federal laws/regulations and accreditation standards
Remains current with ICD-10 Coding changes OASIS guidelines, CMS changes and other agency directives
Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for services
Examines documentation to ensure clinical information is complete and accurate
Review’s information contained in records to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare or Medicaid payment policies
Abstracts review related data/information accurately and timely on appropriate review tool by the appropriate means
Identifies issues requiring clarification or additional information in the clinical documentation and informs Quality/QAPI team for communication with the appropriate care provider using the established processes
Always maintains medical records confidentiality through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices
Collaborates with local leadership and the clinical support team in educating local leadership and clinicians to improve documentation for quality reporting based on trends identified during record reviews
Identifies trends and opportunities for performance improvement and works proactively to find solutions
Assist Compliance and/or Quality Team with any chart reviews as requested by state or federal agencies or from payers as well as internal targeted investigations/reviews
Provide support to ensure that clinical information and quality data utilized in profiling and reporting is complete and accurate
Maintains an open and collaborative working relationship with the patient care team and clinical support team
Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following policies, procedures, and guidelines
Completes assignments in a manner that meets or exceeds the quality assurance goal of 98% accuracy. Average six-to-eight-episode reviews per day
Accurate and timely submission of all administrative and review related documents to appropriate parties
Maintains chain of custody on all documents and follows all confidentiality and security guidelines
Communicates with Corporate Compliance department any reportable findings or issues identified during the location assessment that would potentially put the Company at risk
Communicates assessment findings to location leadership and upline management and provides expertise regarding policy interpretation, process improvement and follow-up actions required
Identifies and communicates recommendations for revisions or modifications of company policies, practices and processes as indicated

Active unrestricted RN license
Associate degree in Nursing or the equivalent
Minimum eight years of clinical experience in a Home Health or Home Care setting required, including a minimum of two years' experience in homecare clinical management and/or operations
Must exercise independent judgment, critical thinking, ability to work independently while following CMS guidelines, organizational policies, and procedures
Knowledge of current Home Health regulations and operations
Medical record abstracting skills required
Knowledge of the organization of medical records, medical terminology, and disease process required
Strong clinical assessment and critical thinking skills required
Excellent verbal and written communication skills required
Ability to work independently and meet targeted review numbers
Flexibility and strong organizational skills needed
Proficiency in computer applications including Microsoft Word and Excel programs. Must be proficient in navigating electronic medical records
Must be proficient in navigating Home Care Home Base

BrightSpring Health Services provides clinical, nonclinical and pharmacy and other ancillary care services. It was founded in 1974, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is https://www.brightspringhealth.com/.

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