LHC Group is the preferred post–acute care partner for hospitals, physicians and families nationwide. From home health and hospice care to long–term acute care and community–based services, we deliver high–quality, cost–effective care that empowers patients to manage their health at home.
Additional Details Conducts thorough clinical review of Home Health, Hospice, Community Based Services, and LTACH documentation in response to governmental medical records requests such as: ADRs, RACs, CERTs, ZPICs, etc. Maintains a standardized approach to clinical review that maximizes inter–rater reliability. Composes professionally formatted letters for submission to the government Is responsible and accountable for initial and if needed, final internal review determinations that establish the decision to appeal any external audit denials. Assists with the management of the appeal process of external review denials to include assignment of appeals and ensuring appeal deadlines are met. Prepares clinical documentation for and participates in Administrative Law Judge hearings to defend payment of denied claims Maintains a current and working knowledge of relevant issues, laws and regulations through relevant websites, periodicals, seminars, training programs, and peer contact. This includes state and Federal regulations governing compliance and reimbursement. Maintains current knowledge of relevant LHC Group policies and procedures related to Compliance, Performance Improvement, Clinical Documentation, Internal Audit, etc. Works with other LHC department's Directors and Managers to coordinate team's activities such that there is a minimum disruption to day–to–day operations. Works with established LHC processes to communicate trends based on audit findings to promote organization–wide corrective action and behavioral changes. Works with the Governmental Audit Manager and Governmental Audit Team to ensure government pay backs as determined through established audit process and procedure. Assists Governmental Audit Manager as needed with any additional Compliance Audits. Performs other duties as assigned.
Formal Education : Bachelor's/Associate's Degree
Experience : 5 years
License, Registration, and / or Certification Requirement: Yes
Education Requirements Degree in Nursing required.
Experience Requirements Minimum of one (1) to five (5) years' experience in hospice, LTAC, and|or home health care, with current and working knowledge of reimbursement and compliance rules and regulations. Experience with auditing and analyzing clinical documentation preferred.
License Requirements Current license and registration to practice as a licensed practical nurse or registered nurse.
Skill Requirements Proficient skills in all Microsoft Office applications (Word, Excel, etc.). Evidence of leadership qualities and effective communication skills. Ability to relate and work well with others within each level of authority and responsibility. Ability to efficiently work independently and meet productivity expectations. Strong critical thinking skills. Ability to easily adapt to frequent process changes