Brookhaven Memorial Hospital Medical Center

Reimbursement Nurse Coordinator - Homecare - Full Time - Day Shift

US-NY-PATCHOGUE
Job ID
2017-9876
Department
Clinical
Position Type
Full-Time
Hours (Work Schedule)
8:30am-4:30pm Monday – Friday

Overview

In accordance with professional nursing practices, policies and standards, reviews OASIS, provides support to intake and establishes appropriate ICD-10 coding and sequencing and will work with clinical staff to clarify documentation and data integrity issues.   Responsible to train new staff on OASIS and coding as it pertains to their job. Provides ongoing education to staff as needed. Reviews denials, TPL’s and other reimbursement and documentation issues.

Responsibilities

  • Facilitates and Provides support related to pre and post payment reviews and other reimbursement issues.
    • Reviews medical records that are involved in medical review with payors including ADRs, TPLs and all pre and post payment audits as well as Livanta (QIO) reviews.
    • Reviews documents being sent to third party payors.
    • Prepares all information required regarding the review and or collaborates with other staff regarding preparation of same.
    • Assures for appropriateness of payor source.
  • Responsible for analyzing consistency of OASIS documentation and assessment processes and data integrit 
    • Reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organizational policy.
    • Ensures appropriate ICD-10 coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities.
    • Consults with appropriate clinical staff to clarify any data integrity issues and works with the clinician to make appropriate corrections per organization policy.
    • Participates in ongoing analysis and reporting of outcome measures and makes recommendations for improvement at the agency and clinician level.
    • Works with managers to address trends that affect the agency’s outcome and process measures noted during OASIS review.
    • Makes OASIS inter-rater reliability visits with clinical staff.
    • Provides orientation and ongoing education regarding OASIS Coding and Payor source.
    • Assists with other chart audit activities as assigned
    • Assumes CHN responsibilities in the field as per departmental needs
    • May support Therapy services as needed including scheduling, coordination, and documentation.
  • PARTICIPATES IN AGENCY PERFORMANCE IMPROVEMENT
    • Reviews an assigned percentage of charts for quality compliance, which includes but is not, limited to care rendered and appropriate billing for services provided.
    • Answers all IPRO requests for information/denials
    • Accepts membership and participates in agency committees.
    • Participates in agency orientation.
    • In conjunction with the Director of Patient Services provides in-service education regarding reimbursement issues and regulatory changes as requested.
    • Participates in case conferences as requested.
    • Knowledgeable of the limitations of insurance coverage for patients.
    • Shares knowledge of insurance limitations with the staff.
    • Maintains all insurance manuals
    • Reviews discharge OASIS for accuracy and follows up with any identified areas of patient decline.
    • Prepares medical records for legal review.
    • Establishes and maintains effective working relationships.
    • Participates actively on all unannounced or scheduled surveys.
    • Accepts other duties as assigned.

 

Qualifications

  • License and current registration to practice as a registered nurse in New York State.

    Two (2) years of medical/surgical experience.

    One (1) year of community health experience.

    Working knowledge of OASIS and ICD-10 coding.   OASIS certification preferred, OASIS Home Health ICD-10 coding certification preferred.

    Working knowledge of Home Health/Hospice reimbursement guidelines.

 

 

 

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