<Company Overview>
Texas Healthcare Solutions Inc is a locally owned and operated licensed and Medicare-certified home health agency serving San Antonio and the surrounding areas. The organization is dedicated to providing professional, personalized healthcare services to individuals in their homes, apartments, or assisted living communities.
<Overview>
We are seeking a highly skilled RN QA/Oasis Review specialist to join our team. This role is essential in ensuring the accuracy, completeness, and compliance of medical documentation within our healthcare operations. The ideal candidate will possess extensive clinical knowledge, experience with various electronic health record (EHR) systems, and a strong understanding of utilization review and medical coding standards. You will play a critical role in maintaining high-quality patient care documentation aligned with regulatory standards such as NCQA and HIPAA.
<Duties>
- Conduct comprehensive reviews of clinical documentation to ensure accuracy, completeness, and compliance with healthcare regulations and organizational policies.
- Perform utilization and Oasis review and management to support appropriate patient care levels in Skilled Home Health and Home Health Infusion setting.
- Collaborate with multidisciplinary teams to facilitate discharge planning, case management, and clinical documentation improvement initiatives.
- Utilize EMR systems such as HCHB, Point Click Care and other EHR platforms for documentation review and data entry.
- Ensure adherence to coding standards including CPT, ICD-9/10, DRG, and ICD coding to support proper billing and reimbursement processes.
- Maintain knowledge of Medicare requirements, NCQA standards, and HIPAA regulations to uphold compliance across all documentation practices.
- Provide training or guidance on medical terminology, anatomy, physiology, and clinical documentation best practices to staff members.
<Experience>
- Proven experience in medical records review within inpatient or outpatient settings; hospital experience, Post Acute, care Coordination and Skilled Home Healthcare.
- Strong familiarity with HCHB, Point Click Care EMR/EHR systems.
- Demonstrated expertise in managed care processes including utilization management and clinical documentation improvement programs.
- Post Acute care experience is preferred; experience with discharge planning or Coordination of Care and Case Management is advantageous.
- Knowledge of medical coding (CPT, ICD-9/10), DRG assignment, OASIS review and MDS completion is advantageous.
- Background in nursing or healthcare case management with acute care, Skilled Home Healthcare exposure enhances suitability for this role.
- Excellent understanding of medical terminology, anatomy, physiology, and health information management principles necessary for accurate documentation review. Join our team as an RN QA/Oasis Review specialist to ensure the highest standards of clinical documentation quality while supporting optimal patient outcomes through meticulous review processes!
Pay: $35.00 - $38.00 per hour
Benefits:
- 401(k) matching
- Dental insurance
- Free parking
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Vision insurance
Work Location: In person
