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Coding Specialist

Education | Duncan, OK | Part Time

Job Description

TITLE: CODING SPECIALIST

REPORTS TO: CLINICAL COMPLIANCE DIRECTOR


MINIMUM QUALIFICATIONS

  1. Is an RN, LPN, or LVN with current licensure to practice professional nursing in the state of practice, or is at least 18 years of age.
  2. Possesses and maintains good physical stamina and mental health, and has completed the agency pre-employment health clearance.
  3. Have satisfactory references from current employers and/or professional peers.
  4. Has an excellent observation and communication (oral and written) skill.
  5. Is self-directed with the ability to work with little supervision.
  6. Must be organized, detail oriented and possess effective communication skills, both orally and in writing. The ability to communicate with a diversity of individuals is required.
  7. Must have good clinical judgment and observation skills.
  8. Must have a positive attitude, is self-directed and has the ability to work with little supervision.
  9. Must be willing to comply with accepted professional standards and principles.
  10. Must be flexible and cooperative in fulfilling role obligation.
  11. Is flexible and cooperative in fulfilling all obligations and maintains positive attitude.


SUMMARY OF JOB RESPONSIBILITIES

The Coding Specialist is responsible for collaboration with multiple disciplines as needed. The

RN/LPN/LVN conducts clinical record audits utilizing agency policy and procedures, federal and

state regulations and agency education guides. On an emergent basis, for the agency good and

patient/client need, the RN/LPN/LVN Coding Specialist performs patient/client care visits.


RESPONSIBILITIES AND DUTIES

  1. Provides a positive work environment by consistently modeling in a positive way, the agency philosophy, mission, values, and standards of care, and providing a professional role model for other staff. Assist with educating field staff on new process.
  2. Adheres to HIPAA regulations and follows agency protocol maintaining confidentiality and does not improperly disclose of patient information.
  3. Complies with all agency policies and procedures.
  4. Is diligent in activities that ensure advanced proficiency in Homecare Home base (HCHB) Electronic Health Record (EHR). Actively seeks out training and continuing education in agency processes including participation in offered classroom training and e-learning courses. Communicates as appropriate with staff, physicians, referral sources, community, patients, potential patients, caregivers, and others involved in care.
  5. Demonstrates understanding of the Agency’s mission, vision, philosophy, and standards of care, through behaviors, which supports this.
  6. Assist by giving recommendations to ensure patients on services meet criteria established by their payer source such as medical necessity and homebound status and ensure documentation clearly indicates the criteria are met.
  7. Assist by reviewing the quality of the documentation, that assessing clinicians and ancillary staff provides exceptional patient care by utilizing all elements of the nursing process and/or agency standards of care, and the level of care and services provided coincide with the patients’ level of acuity and meet their needs.
  8. Completes Client Related Task of Perform Oasis QA, Review SHP, and 485 Coding which presents in workflow once the Clinical Field Staff Supervisor has completed the initial QA of oasis assessment, assist by providing recommendations to ensure quality care, quality documentation, criteria met for patient to qualify for services and plan of care established to meet the needs of the patient.
  9. Review all required items such as, Oasis visit Note (for information regarding patient status), Medication Profile (assist with reviewing contraindications),485/Problem Statements/Care Plans (to ensure proper coding, goals, and pathways), Coordination notes, Case Mix Details and Insight Report (for insight into clinical, functional, and service areas), Medicare Utilization Summary (Episode Analysis Tool to manage financial viability, revenues, costs, and visit details).
  10. Review non-required items as indicated such as Vital Sign Parameters (to ensure patient specific parameters are set), Previous Orders, Pharmacy Info, Attachments, etc. Reviews EHR to see if physician contact was made by the field nurse and ensure action is documented. By providing recommendations to DON, Clinical Field Staff Supervisor, and Assessing Clinician, assist with ensuring proper care is provided to the patient by following-up on physician notifications and collaborating with them to update the plan of care to include additional visits, update teaching plans, etc. to meet the needs of the patient and then communicate with patients as warranted.
  11. By providing recommendations to the DON, Clinical Field Staff Supervisor, and Assessing Clinician, assists with ensuring continuity of care and follow-up with patient as indicated, ensures orders were written as necessary to accommodate patient needs, ensure meds/calendar was updated as indicated, and ensure documentation is thorough.
  12. By providing recommendations to the DON, Clinical Field Staff Supervisor, and Assessing Clinician, assists with monitoring visit frequency, documentation, costs and patient outcomes. Adjusts plan as needed for safety and improvement of patient’s condition, ensuring the stabilization and/or improvement of the patient’s outcomes.
  13. Coordinate with Assessing Clinician and Clinical Field Staff Supervisor to assist in establishing short and long term therapeutic goals and setting priorities by making recommendations. Receive authorization from the assessing clinician to make necessary edits to reflect an accurate assessment and to provide patient with appropriate pathways, interventions and services. Coordinate with assessing clinician and Clinical Field Staff Supervisor to establish a plan of care.
  14. Reviews various types of coordination notes which communicate pertinent patient information or data related to patient care and provision of services.
  15. Reviews additional assessment comparison tools such as SHP (Strategic Health Care Programs) to measure outcomes, to ensure OASIS/coding accuracy, and to ensure services provided to patients is concurrent with National and State Standard. Completes data updates on alerts/dashboard for each office daily, and checks SHP transmissions of assigned offices with each transmission.
  16. Reviews/Edits 485 for thorough review of all data fields making spelling and grammar corrections, assist with ensuring orders concur with assessment and OASIS documentation, and goals/interventions are specific to patient needs. Once all review and corrections made, will edit or create the visit note recommendation coordination note, submit 485 Review Coordination note to Clinical Field Staff Supervisor and Critical Recommendations Coordination note to DON. Work flow will then go to DON for review/edit/approve of 485 and locking oasis.
  17. Reviews oasis (determined by payor source) assessments that do not come to coding workflow as follows: ROC, Transfers, and Transfers with Discharges evaluation documentation. Collaborating with the assessing clinician and Clinical Field Staff Supervisor to receive authorization to make edits as necessary. Assist with ensuring new/changed medications have been added to the profile, etc. Once all review and corrections complete, will edit or create visit note recommendations coordination note, submit 485 Review Coordination note to Clinical Field Staff Supervisor and Critical Recommendations Coordination note to DON.
  18. Constantly reviews workflow screen. Diligently and accurately completes all tasks included within client related tasks, coordination notes.
  19. By providing recommendations to the DON, Clinical Field Staff Supervisor, and Assessing Clinician assist with ensuring customer service is being provided to all patients, physicians and other affiliates.
  20. By providing recommendations to the DON, Clinical Field Staff Supervisor, and Assessing Clinician assist with ensuring medication errors are documented into the database upon occurrence. Collaborate with Clinical Compliance Director receive direction on further action.
  21. By providing recommendations to the DON, Clinical Field Staff Supervisor, and Assessing Clinician assist with ensuring occurrences are recorded in the database upon notification and collaborates with Clinical Compliance Director to receive direction on further action.
  22. By providing recommendations to the DON, Clinical Field Staff Supervisor, and Assessing Clinician assist with ensuring field staff follows protocols and take necessary action to prevent the spread of infectious diseases. Assist with ensuring the infection logs are completed.

Disclaimer: The above statements are intended to describe the general nature and level of work

being performed by people assigned to this classification. They are not to be construed as an

exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All

personnel may be required to perform duties outside of their normal responsibilities and will be

directed by their Clinical Compliance Director as the need arises.


WORKING CONDITIONS

  1. General office.
  2. Work is moderate with a combination of sitting, standing, and walking.
  3. Community and client home environment.
  4. Potential exposure to blood and/or body fluids and infectious disease during the performance of job duties.
  5. Potential exposure to extreme temperature and humidity when traveling and while in client homes.
  6. Potential exposure to dust, gas, fumes, and odors during traveling.
  7. This position has been designated as clinical management (see Infection/Exposure Control Plan). Employees performing clinical management duties may be involved in potential exposure to bloodborne pathogens and other potentially infectious materials. All clinical management employees will be offered Hepatitis B vaccination at no expense to the employee.


PHYSICAL REQUIREMENTS

  1. Visual and manual dexterity is required.
  2. Good physical stamina and mental health is required. Has completed the agency pre-employment health clearance.
  3. Ability to perform tasks involving physical activity, which may include heavy lifting and extensive bending and standing.
  4. Ability to deal effectively with stress.


CONTINUING EDUCATION REQUIREMENTS


The Coding Specialist must meet the required continuing education hours for state certification as a

nurse in Texas as applicable. Agency personnel are expected to participate in appropriate

continuing education as may be requested and/or required by their immediate supervisor. In

addition, agency personnel are expected to accept personal responsibility for other educational

activities to enhance job related skills and abilities. All agency personnel must attend mandatory

educational programs.


I have read, and fully understand all information in the above job description. I meet the stated job

qualifications, and am mentally and physically able to perform the responsibilities and duties of the

above job description.