Job Description

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

Description

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

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

Responsibilities:
  • 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

Qualifications

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

Experience:
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

Travel: 
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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