- Professional
- Oficina en Troy
Hospice Quality Review Specialist
Job Description
Position Summary:
The Hospice Quality Review Specialist is responsible for analyzing data integrity and consistency of Hospice documentation and assessment processes. This position will ensure appropriate ICD-10 coding and sequencing and will work with clinical staff to clarify documentation and data integrity issues.
Duties and Responsibilities:
• Prospectively reviews all Hospice assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy.
• Monitors HOPE measures or alert reports when reviewing HOPE data.
• 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 clinicians to make appropriate corrections per organization policy.
• Reviews visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and/or underutilization to the clinical manager/designee.
• Notifies organization leadership of problematic trends, as a result of documentation review.
• Works with managers to address trends that affect the agency’s outcome and process measures noted.
• Participate in Quality Improvement and Corporate Compliance activities as assigned.
• Assists with other chart audit activities as assigned.
• Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications.
• Performs other duties and activities as delegated by the Director of Hospice.
Qualifications:
• One (1) to two (2) years of clinical Hospice experience required.
• Working knowledge of Hospice compliance and ICD-10 coding.
• Knowledge of federal regulations and state licensure requirements.
• Working knowledge of computer systems.
• Licensed driver with automobile that is in good working order and insured in accordance with organization requirements.
• Excellent coordination and communication skills.
• Detail oriented and able to work with minimal supervision.
