Covenant HealthCare

Summary:

The Hospice and Palliative Care Quality RN provides timely and accurate quality review, clinical coding, and HIS review expertise to ensure optimal reimbursement for professional services performed within the Hospice and Palliative Care service line. This position is responsible for collaboration with coding company in relation to ICD10 diagnosis coding for all hospice patients as well as quality review/coding validation of professional billing charges within the Palliative Care program. This person must be able to troubleshoot, and problem solve billing and reimbursement issues with the support of the clinical Coordinator and Manager. Works well with the intake, liaisons, office staff and management teams. Stays current on professional coding changes, compliance, issues, billing, documentation, Hospice Item Set requirements, and reimbursement. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.

Responsibilities:

Contributes to organizational success targets for patient satisfaction. Assure all communication, both written and verbally, is tactful, effective, positive and professional. Formulates and utilizes relationships with all members of the VNA team and physicians. Adhere to coding rules/regulations to ensure quality coding based upon documentation within the patient record. Follows policies, procedures, and guidelines to assure consistent coding and documentation quality. Utilizes analytical skills when reviewing charts and interpreting documentation when applying codes. Knowledgeable and utilizes numerous references to support coding decisions. Demonstrates knowledge of ICD-10 diagnosis coding rules, conditions, and regulations. Ensure the initial Hospice Plan of cares are reviewed and completed in a timely manner with appropriate feedback when changes are needed. Complete review of Recertification and Discharge Plan of cares for completion and compliance. Coordination of SNF/Facility based documentation requirements. Maintain compliance with Admission and Discharge HIS submissions. Review required documentation for accuracy/completion and provide feedback when needed. Independent learner with desire for personal and professional growth. Assist in data collection/review for Hospice and Palliative Care QAPI plan and participate in action plans as requested. Stays current on Hospice coding, Hospice HIS, and professional billing/Palliative care coding guidelines particularly from the Center for Medicare/Medicaid Services (CMS). Demonstrates coding knowledge as it directly correlates to Hospice qualification. Works well with all staff, maintains positive working relationships and exhibits willingness to help others. Collaborates with coding company to ensure all coding is completed in a timely manner within the Hospice guidelines/timelines and billing guidelines. Supports all levels of staff on coding and documentation requirements for hospice and palliative care. Proves to be excellent at problem solving, researches topics when necessary and makes recommendations as needed. Able to identify solutions to problems and assists in the resolution. Proves to be self-motivated and works independently with the ability to make sound decisions, analyze issues and solve problems. Shares knowledge during training of new staff and is a resource to others. Performs specified coding audit when necessary or as needed. Maintains professional credentials. Assure that all legal requirements, both federal and state, are followed and met. Demonstrates awareness of legal/confidentiality issues and adheres to the Health Insurance Portability and Accountability Act (HIPAA) privacy and security regulations. Demonstrates knowledge and adherence to Covenant HealthCare and VNA policies and procedures. Provide clinical patient care as a Hospice RN if requested. Other duties as assigned.

EDUCATION/EXPERIENCE REQUIREMENTS Registered Nurse with current licensure in the State of Michigan. ICD-9 or ICD-10 education preferred within the past two years. Certificate not necessary. Experience in coding using the ICD-9 or ICD-10 criteria in a professional setting preferred. Minimum 2 years’ experience in Hospice and/or Home Health Care. Hospice and Palliative experience preferred. KNOWLEDGE/SKILLS/ABILITIES Demonstrated competency in computer efficiency using Delta/Encore, EPIC, Microsoft Office, Outlook, internet, and other software as needed. Knowledgeable in medical terminology and anatomy. Knowledge of standard office equipment. Demonstrates effective communication skills, both verbally and written. Demonstrates effective organization skills and able to prioritize to complete work timely and accurately. Able to effectively identify problems and to provide a sound solution. Demonstrates excellent interpersonal skills, maintaining a professional demeanor, while working with many people and personalities. Able to use sound judgement to make the best decision based on knowledge on CMS guidelines, Federal and State rules and departmental policies. Willingness to learn new programs and maintain knowledge on coding regulations. Flexible in time management and adjust assignments as priorities change. WORKING CONDITIONS/PHYSICAL DEMANDS Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards. Constant sitting, handling, fingering, feeling, hearing, and near vision. Frequent midrange vision, far vision, depth perception, color vision and field of vision. Frequent lifting 0-10 lbs. Occasional standing, walking, lifting, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting, crawling, twisting, reaching and talking. Occasional lifting 11-50 lbs.