Overview:

The Audit Specialist – Home Health position provides audit, consultant support and written reporting necessary to optimize clinical reimbursement, clinical practice, quality assurance and compliance, and reimbursement through consultant directed and proactive chart audits within our Home Health division of consulting. This LPN or RN level position requires specific and deep knowledge of the patient driven groupings model, OASIS starts of care and discharges as well as the impact of these models and processes on quality measures and overall home health payment.  This position also requires an intermediate understanding of regulations for submission of various documentation, other regulations, etc. that may impact overall reimbursement and payment.

The position accomplishes all of the above through a respectful, constructive and energetic style, guided by the objectives of the company.

As one of the company’s expert and detailed auditors and clinical reimbursement support, this position functions as a member of the Company’s clinical strategies consulting division, in alignment with our mission and values. Must be an LPN or RN AND with a reimbursement understanding and be willing to travel throughout the US on an as needed based at times. MUST have OASIS and home health operations experience.

Reports to:     Senior Vice President of Clinical Strategies + Consulting

Responsibilities:

Clinical and Compliance Management:

• Completes remote and onsite PDGM, OASIS, & QM audits as indicated
• Participates in video conferencing and educational webinars as needed
• Collaborates with Consultants on projects as assigned
• Maintains a caseload of auditing consulting clients, working with those consultants and clients to complete audits, reporting and review in a timely manner
• Participates in ongoing clinical strategies consulting updates and trainings as indicated to stay up to date on reimbursement or charting changes, etc.
• Stays up to date on industry trends, regulations, reimbursement changes, and other changes as needed to be effective in the current

Customer Relationships:

• Supports excellence in customer relationships and meets with appropriate home health team members with regular written, verbal and in-person
• Addresses customer and employee concerns in timely manner and communicates issues to Senior Management as needed
• Reinforces communications from the Company regarding regulatory and other industry updates

Qualifications:

• Degree in Nursing required
• Current license in at least one of the state(s) assigned
• Minimum of 5 years of home health clinical reimbursement experience, including OASIS
• Clinical understanding of Home Health Quality Measures
• COQS or Home Health Coding certification a plus
• Highly skilled in virtual and technological communications and interactions

• Must pass Medical and Physical examination based on job qualifications, requirements and duties/responsibilities
• Valid driver’s license and means of personal transportation to service multi state geography as defined