SERVICE INTEGRITY SUPPORT SPECIALIST presso Avow Hospice

Description

Job Summary: The Service Integrity Support Specialist supports the Service Integrity team in completion of work. The individual in this role will process quality data to ensure charts are ready for submission to HCQIS Access Roles and Profile (HARP) / iQIES. The Service Integrity Support Specialist completes provider credentialing and works closely with the providers and schedulers. They analyze and interpret documentation in the medical record utilizing current coding classification system, perform chart audits and provide education and training on coding. This individual has the ability to use independent judgment and to manage and impart confidential information and the ability to analyze and solve problems. They must have strong communication and interpersonal skills. The Service Integrity Support Specialist has a working knowledge of the hospice and home health quality reporting program, legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation. They will stay abreast of developing issues and trends in medical coding procedures requirements and have the ability to clearly communicate medical information to professional practitioners and/or the general public. The Service Integrity Support Specialist has a working knowledge of medical coding systems, procedures, and documentation. Home Health coders will review OASIS and become certified within one year.

Essential Job Functions:

• Review all necessary information from medical records to assist the Medical Director/hospice team physician(s) to identify the terminal diagnosis for hospice and all other conditions whether related or nonrelated using current coding classification system.
• Code records using ICD-10-CM coding guidelines.
• Review the Home Health OASIS records. Review documentation and provide ICD-10 coding recommendations based on current coding and Oasis guidelines.
• Code new admissions for primary and supporting diagnoses based on doctor’s recommendations and documentation received in the medical record.
• Update the medical record with additional diagnoses as patient’s condition changes and review of documentation noted at Interdisciplinary Team Meetings.
• Audit medical record documentation. Will identify undercoded and upcoded services as well as regulatory compliance; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.
• Provide second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
• Research, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
• Interact with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
• Attend coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
• Work with the Medical Staff, Service Integrity, Team Administrators and Leaders to provide feedback to support educational opportunities on coding and clinical documentation.
• Request additional medical records as needed for supporting documentation
• Stay up to date on changes to the physicians fee schedule and other coding resources such as IDC-10 codes.
• Maintain privacy and confidentiality of patient's Protected Health Information (PHI) according to Avow’s organizational policies and procedures. • Compile information to assist in analyzing Quality Control and Performance Improvement audits.
• Maintain knowledge of current coding guidelines and obtains continuing education units to maintain coding credentials.
• Prepare the organization for changes in coding requirements.
• Understand the HOPE tool and will process HOPE data.
• Complete provider credentialing.
• Provide back up to provider scheduling.
• Monitor HIPAA compliance and reports breaches to the Privacy Official.
• Assist with other coding initiatives for any Avow Inc. and all subsidiary clinical companies.
• All other duties as assigned.

Core Values:

Innovation:
We embrace change and are always looking at creative ways to solve problems and serve new populations.

Integrity:
We are honest, hardworking, fiscally responsible professionals driven solely by the well-being of our patients, their loved ones, and the communities we serve.

Collaboration:
We know we cannot achieve everything we want without working hand-in-hand with each other, with our healthcare partners, and with the community.

Celebration:
We believe in the importance of celebrating life and relationships.

Education:
We believe it is important not only to serve the community but to educate community members about our services and the role we can play at the end of life.

Qualifications

Education/Experience: Associates degree; or three years related experience and/or training; or equivalent combination of education and experience preferred. Credentialed in coding (CPC, CCS, CCA) required within 1 year. Home Health Coders will require certification in OASIS within 1 year. Minimum of 3 years of experience in billing and coding with hospice or home health experience preferred.

Certificates, Licenses, Registrations: Certified Professional Coder (Required within 1 year) Current Driver’s license.

Physical Demands: (The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) While performing the duties of this job, the employee may be required to sit, stand, walk, and reach with hands and arms, use hands to finger, handle, or feel. The employee may be required to stoop, kneel, crouch, or crawl. The employee may need to lift and/or move up to 10 pounds. Employee may also be required to see, hear, and talk.

Work Environment: (The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) The noise level in the work environment is usually moderate.

Compensation and Benefits:
This is only a summary of our employee benefits; it is subject to change.

• Medical insurance (PPO) with prescription drug co-pay or HDHP w/HSA
• Supplemental Benefits (hospital confinement, accident and/or cancer)
• Dental insurance
• Vision Insurance
• Life and accidental death/dismemberment insurance (company paid)
• Long term care insurance (company paid)
• Retirement savings plan (TSA/403(b) matching program)
• Short and long term disability insurance (company paid)
• LegalShield (identity protection and more)
• Bereavement leave for family and pets
• Direct deposit
• Credit union availability
• Employee Assistance Program
• Paid time off
• Mileage reimbursement
• In-house continuing education opportunities
• Discounted membership at local area Fitness Center
• Tuition reimbursement
• Other employer-sponsored activities

Avow is a Tobacco Free Organization which includes but is not limited to cigarettes, electronic cigarettes, vaping, cigars, cigarillos, pipes, chewing tobacco, snuff, dip, and loose tobacco smoked via pipe or hookah. And due to the above, Avow will only hire Nicotine Free individuals.