Job Description

Job Title: UM Coding & Review Specialist - Home Health
Job ID: 56825455
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: Home Nursing Agency
Department: Home Health Dept
Location: 20 Sheraton Drive, Altoona PA 16603


This position could report to the Altoona office or North Pointe Office.

To provide support involving medical data, information technology, electronic health records and health information management to the utilization management department.

  • Expand knowledge and expertise through educational resources and literature review
  • Demonstrate support of the Agency's Mission, Principles, and Values, Ethics & Standards of Behavior 
  • Performs in accordance with system-wide competencies/behaviors
  • Demonstrate ability to effectively communicate with all members of the healthcare team
  • Maintain and protect patient and agency confidentiality
  • Educate and require adherence to performance improvement processes and initiatives
  • Confirm OASIS scoring and/or documentation is reflected in projected visit pattern; identify any variance to established parameters and consult accordingly with Utilization Manager
  • Achieve and maintain ICD 10 coding expertise (as evidenced by corresponding certification) and function as a resource for clinicians with coding questions
  • Demonstrate proficiency in Medicare, Medicaid, and Commercial insurance regulations
  • Responsible for processing of Plans of Treatment in conjunction with clerical personnel
  • Provide support to the Utilization Management Department as necessary
  • Responsible for assuring an efficient and customer friendly communication with internal and external customers
  • Responsible for overall review and processing of assigned Home Health clinical records at specific time frames including start of care, resumption of care, recertification and ongoing as required
  • Examine OASIS, identify discrepancies utilizing SHP software, validate accuracy and ensure comprehensive completion of the assessment
  • Consult with appropriate clinician as necessary, in conjunction with Utilization Manager
  • Validate accuracy of diagnosis, ensure appropriate ranking of diagnosis and assign corresponding ICD 10 codes
  • Consult with Clinical UM Reviewer/UM Supervisor with admission identified as high skill level and/or complex care


High School graduate required
LPN or Associates Degree is required or program enrolled 

Minimum two years related healthcare work experience
Computerization skills: Demonstrate ability to perform computer skills in specialized computer application(s) as needed

Special Requirements: 
1. Related course work in medical terminology or demonstrates a strong working knowledge of medical terminology
2. Working Knowledge of ICD 10 Coding
3. Working Knowledge of OASIS4
Demonstrates high level critical thinking skills

Position requires travel to various office sites, valid PA drivers' license and proof of auto liability required

Licensure, Certifications, and Clearances:
Certification of ICD 10 Coding obtain within one year of hire.Certification of OASIS obtain within one year of hire. LPN if applicable.

  • Act 34

  • UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

    Salary Range: $13.69 to $20.84 / hour

    Union Position: No

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