HealthPro Heritage is currently seeking a Clinical Quality Review Specialist for the Oklahoma City market. The ideal candidate will be a Physical Therapist Assistant - PTA or Certified Occupational Therapy Assistant - COTA with experience in home health. Experience in Homecare Homebase a plus!
The Clinical Quality Review Specialist is responsible for processing and completing assigned quality and clinical workflows, identifying errors and omissions in clinical documentation, and providing education to reduce documentation errors.
The following is a list of specific duties, which are considered to be essential functions of this job. The list is not exhaustive as all duties are subject to change. This is consistent with our need to be flexible and responsive to the needs of our customers, patients, co-workers and associated policies. The employee who occupies this position is expected to assume any/all duties assigned by management, irrespective of whether such duties are specifically included in this list. While an effort has been made to thoroughly describe the customary manner in which this job is performed, reasonable accommodation will be made upon notification for qualified individuals with disabilities who may not be able to perform the job in the manner indicated.
- Collaborate with clinicians to achieve accurate documentation and plan of care development, including visit utilization targets and identification of hospitalization risk, to produce strong clinical outcomes.
- Provide clinician-specific education regarding quality, outcomes improvement, documentation standards, and actions to improve clinical processes.
- Participate in quality improvement initiatives within the department.
- Collaborate with home health agencies on focused quality improvement initiatives to achieve the organization's strategic aims and top decile clinical outcomes.
- Identify errors and omissions in clinical assessments, OASIS, coding, plans of care, and other clinical documentation.
- Must be PTA or COTA.
- Maintain a cooperative working relationship with staff and clinical departments.
- Maintain organizational, employee and patient confidentiality at all times.
- Proven experience auditing cases and understanding the differences between coding and clinical language.
- Knowledge of Medicare, Medicaid and other third-party billing rules and regulations required.
- Experience with clinical documentation, charging, billing compliance and coding.
- Excellent written, analytic problem solving, human relations and communication skills
- Professional systems application experience required.
- Data tracking experience required.
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