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Career Opportunities/

QA Nurse

Essential Functions:

• Effectively organizes, prepares, records and analyzes documentation review data on a daily basis for Medicare and other payors.

• Reviews clinical documentation for accuracy and completion including, home health coding, OASIS, and Plan of Cares/485s.

• Processes clinical documentation including OASIS, evaluations, visit notes, physician orders, Plan of Cares, face-to-face, medication profiles, and interventions/goals to ensure compliance with agency policies and Medicare regulations.

• Identifies and proactively communicates documentation errors to field clinicians and the clinical team. Reviews documentation with clinicians and assists with accurate completion of the documentation prior to approval.

• Coordinates with clinicians to ensure that documentation is reviewed and submitted within Agency guidelines.

• Educates field clinicians and the clinical management team about HomeCare Maryland’s documentation policy, as well as Joint Commission and Medicare documentation requirements in an effort to help minimize documentation errors and claim denials.

• Proactively communicates concerns about past due documentation with the clinical team.

• Reviews Kinnser QA hotbox on a daily basis and contacts clinicians for past due documentation or escalate issues to the clinical management team.

• Tracks clinical documentation issues and relays findings to the management team.

• Collaborates with the clinical team and Clinical Educator about additional training needs or recommends new training material to aide in documentation accuracy and completion.

• Assists the Performance Improvement Nurse with chart audits and updating or revising agency policies as needed to ensure compliance with the State and Federal regulations and law.

 

Qualifications/Requirements:

• Current Maryland License Registered Nurse (RN)

• Current CPR license

• Bachelor’s degree from accredited college/university or equivalent experience preferred

• 2-4 years home care experience preferred

 

Technical/Clinical Skills:

• Experience with Microsoft Office Suite and Kinnser software preferred

• Knowledge of medical terminology, home health coding (ICD-10), OASIS, Plan of Cares/485s and all home health documentation requirements, including a working knowledge of home health state and federal regulations

• Knowledge of Medicare/Medicaid/OASIS/Commercial Insurance reimbursement requirement

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