Clinical Coding and OASIS Reviewer

Remote role but must be willing to work 8:30-5 Eastern time.

Please note- Candidates must have COS-C, HCS-O or COQS and HCS-D or BCHH-C certifications in order to be considered.

BAYADA Home Health Care has an immediate opening for a Full Time, Quality Reviewer with OASIS certification to work remotely. RN’s with certifications will be considered for this role.

The Quality Reviewer is responsible for auditing, validating, and optimizing the patient’s Plan of Care (Form CMS-485) and OASIS assessments. This role ensures clinical accuracy, regulatory compliance with Medicare/CMS guidelines, and appropriate reimbursement for home health services.

BAYADA Perks:

• This is a fully remote position.
• Base Salary: $77,000 - $80,000 / year
• BAYADA offers a comprehensive benefits plan that includes the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit, and employee assistance program.

Responsibilities:

• Compare the CMS-485 against referral documents, History & Physical (H&P), OASIS, and therapy/nursing evaluations for 100% consistency and medical necessity.
• Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy.
• Timely review and coding of diagnoses and OASIS documents with productivity maintained at the quarterly target set by the Director of MCM.
• Review clinical information for appropriateness, congruency, and accuracy as it relates to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines.
• Provide support and communication to all disciplines within the service.
• Provide customer service/education and act as a resource to Medicare Certified Offices with regards to CMS guidelines, PDGM guidelines and billing related issues.
• Provide ongoing communication with service offices via e-mail, zoom, or telephone (specific to the service office needs).
• Communication with service offices monthly and as appropriate with a focus on documentation trends, star ratings and potential revenue impact.
• Perform related duties, or as required or requested by Manager/Director.

Qualifications:

• Competency in PC skills required to perform job function.
• Active Compact RN Nursing License, with a minimum of 2 years clinical experience.
• COS-C or HCS-O or COQS OASIS Certification and experience required.
• HSC-D or BCHH-C.
• HCHB experience, a plus!