The Senior Coding & OASIS Specialist is responsible for overseeing and managing the accurate and compliant coding of diagnoses and procedures using ICD-10 standards and ensuring the proper use and documentation of Outcome and Assessment Information Set (OASIS) data at Medalogix. This role helps us develop innovative software solutions with a specific emphasis on elevating Medalogix organizational maturity in clinical coding. It combines advanced coding expertise with a deep understanding of OASIS assessments to enhance patient care quality, ensure regulatory compliance, and support optimal Home Health billing and reimbursement processes. The primary objective of this role is to ensure high-quality, compliant, and efficient healthcare documentation and coding practices are followed within our products, maintain and build data governance around coding regulations, improve operational efficiency, and optimize financial performance for our clients. A great candidate will bring deep coding experience, a passion for driving changes in the industry, and an excitement to be part of a fast-growing software company.
KEY RESPONSIBILITIES:
- This role is a corporate services role responsible for supporting all coding and OASIS subject matter support needs cross-functionally, including but not limited to product, client success, implementations, information technology and informatics, finance, administration, legal and regulation affairs, communications, and marketing.
- This role is designed for a professional who excels in client-facing interactions and possesses the vision to create and design groundbreaking programs. The ideal candidate will leverage their expertise to develop and implement strategies that drive client success and position our organization as a leader in the industry.
- Serve as the go-to expert for ICD-10 coding and compliance, providing deep knowledge and insights to both clients and internal teams to lead and address coding and documentation questions or issues to ensure overall quality and completeness of clinical documentation.
- Support training sessions with our clients on product impacts to current coding & billing, process and financial/payment outcome measure results, and OASIS recommendations. Provides mentoring and education to our client’s clinical leadership to improve their current performance in all related areas.
- Work closely with the other Medalogix Clinical Services team members, (i.e., Data Science, Product, Research & Development, Compliance, etc.) to interpret, lead and provide coding guidance. This role will drive change with our clients and internal stakeholders, to develop efficient workflows to organize and prioritize complex coding needs to ensure compliance with regulatory requirements.
- Knowledge of Health Insurance Prospective Payment System (HIPPS) and Home Health Resource Group (HRRG) codes payment/reimbursement and case mix analysis and provide guidance and consultancy on accuracy in reflecting the utilization of resources during patient encounters to reflect the appropriate codes.
- Proactively identify documentation gaps or inconsistencies that may impact code/clinical category assignments and client ROI outcomes; initiate client-specific coding queries or tasks to research, clarify documentation, and ensure accurate code assignment.
- Demonstrate advanced coding knowledge and OASIS practices; provide guidance and support to coding staff and clients on complex coding scenarios and regulatory requirements.
- Serve as a data governance steward organizationally to ensure that codes are updated and maintained corporately according to CMS guidelines.
- Stay updated on changes in coding and OASIS guidelines and regulations through ongoing education and training to present cross-functionally and serve as a subject matter expert in coding.
- Conduct quality reviews, as needed, to validate coding and PDGM group assignments to ensure compliance with Coding Guidelines.
- Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions, adapt to changes in workload, and work schedule and to respond quickly to urgent requests.
Requirements
- Must have 5 years of experience in home care required. (Clinical or certified coder or OASIS reviewer)
- Expert in home health or home health and hospice coding experience (cannot only be hospice experienced)
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required. Must be current coding certified (BCHH-C or HCS-D), and OASIS certified (COS-C, COQS or HCS-O) and maintain certifications
- Must have a minimum of 3 years of routine coding and OASIS review experience
- Professional license requirement of RN, PT, OT, or ST.
- Preferred: Knowledge of more than 1 EMR system and the ability to learn others quickly and work in them efficiently and productively
- Ability to analyze and make informed decisions with complex data, and processes, identify gaps, and propose solutions for workflow optimization.
- Homecare Homebase, Matrix Care, and other industry home care EMR experience strongly preferred.
- Working knowledge of CMS Condition of Participation in Home Health
Benefits
- Health Care Plan (Medical, Dental & Vision)
- Retirement Plan (401k, IRA)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off (Vacation, Sick & Public Holidays)
- Family Leave (Maternity, Paternity)
