Essential Functions

Medical Coding & Documentation:

▪ Accurately assign ICD-10-CM diagnosis codes based on clinical documentation and home health-specific coding guidelines.

▪ Ensure compliance with CMS, OASIS, PDGM, and payer-specific regulations, adhering to the latest industry updates.

▪ Review and analyze patient records to validate appropriate code selection, ensuring medical necessity and optimal reimbursement.

▪ Extract and interpret clinical data from OASIS assessments, ensuring correct sequencing of primary and secondary diagnoses and procedures.

Data Accuracy & Patient Information:

▪ Identify and report coding discrepancies, documentation gaps, and potential compliance risks to enhance data integrity.

▪ Verify correct ordering and documentation of diagnoses and procedures to support accurate reporting and billing.

Medical Chart Review:

▪ Ensure that all assigned codes accurately reflect patient conditions, level of care, and medical necessity as documented in clinical records.

▪ Assist in documentation improvement initiatives, providing feedback to enhance clarity and accuracy.

Quality Assurance & Process Improvement:

▪ Maintain a 90–95% coding accuracy rate, consistently meeting quality benchmarks.

▪ Develop and implement quality assurance protocols to ensure coding compliance and efficiency.

▪ Analyze data trends to identify areas for improvement and recommend solutions to enhance documentation accuracy and efficiency.

Compliance & Security:

▪ Strictly adhere to HIPAA, Information and Data Security protocols, and healthcare BPO regulatory standards to safeguard patient information.

▪ Follow organizational guidelines to maintain data integrity and confidentiality in all aspects of coding and documentation.

Regulatory & Industry Updates:

▪ Stay informed about evolving medical coding guidelines, industry regulations, and best practices to ensure compliance and coding accuracy.

▪ Adapt to new CMS, PDGM, and payer requirements, integrating changes into daily coding practices.

Audits & Compliance Reviews:

▪ Participate in internal and external audits to support organizational compliance and quality objectives.

▪ Provide detailed reports on audit findings, corrective actions, and recommendations for continuous improvement.

Reporting & Documentation:

▪ Track and document productivity and quality metrics, aligning with organizational performance goals.

Confidentiality & Ethical Standards:

▪ Handle sensitive medical information with strict confidentiality, adhering to ethical standards in all aspects of medical coding and documentation.

▪ Uphold professional integrity, ensuring all coding practices meet ethical and legal standards.

Software & Technology Adaptability:

▪ Demonstrate the ability to learn and efficiently utilize new medical coding software, EMR systems, and industry-specific technologies.

Hiring Requirements/Preferences

▪ Bachelor’s degree preferred (Health Information Management, Medical Science, or related field).

▪ 1+ year of Home Health coding experience preferred (OASIS, PDGM, post-acute care coding desirable).

▪ Certification required/preferred: HCS-D, CPC, CCS, or equivalent.

▪ Expertise in ICD-10-CM, PDGM, OASIS, and home health regulatory compliance.

▪ Proficiency in English (verbal and written) for accurate documentation and collaboration.

▪ Strong knowledge of anatomy, physiology, disease processes, pharmacology, and medical terminology.

▪ Familiarity with home health coding standards, CMS, and payer guidelines.

▪ Proficient in EHR, medical coding software, and Microsoft Office.

Please refer to job description.