This position is a remote work from home position and available to qualified candidates across the country.
Description of Responsibilities:
Performs ongoing auditing of selected Medicaid and Medicare claims as well as other payers as directed. Utilizes the audit findings to identify provider strengths and weaknesses. Develops related training and education materials and provides education as appropriate. Involved in the research for updating and/or revision of state specific regulations pertaining to home health regulations. Submits new regulations and/or revisions to the existing state policy manual for approval by policy committee. Uses company resources to provide support, direction and feedback to office management and regional clinical support staff related to state specific policy, regulatory requirements and intermediary guidelines. Participates in various company compliance initiatives, collaborates with others and provides input as appropriate. Supports the execution of the company’s annual compliance plan. Works under general supervision.
• Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
• Performs ongoing auditing of selected Medicaid and Medicare claims as well as other payers as directed. Utilizes the audit findings to identify provider strengths and weaknesses. Develops related training and education materials and provides education as appropriate.
• Involved in the research for updating and/or revision of state specific regulations pertaining to home health regulations. Submits new regulations and/or revisions to the existing state policy manual for approval by policy committee.
• Participates in evaluating new/proposed company initiatives and programs that bear relationship to departmental responsibilities and objectives as appropriate.
• Manages projects as assigned that relate to identified department initiatives, ensures timely completion and implementation of new programs as scheduled.
• Tracks and trends audit data findings. Provides consultation and assistance with interpreting
audit data, summarizing and completing report findings and ensures development of process
improvements based on findings as appropriate.
• Monitors and supports compliance to company billing practices and keeps all levels of field
organization informed of issues related to billing regulations and compliance. Provides
guidance to field organization on compliance issues, interpretation of coverage issues, audit
process and billing questions.
• Participates in the department’s audit process in reviewing of claims for compliance to
company billing practices. Consults with field support staff and office administration
regarding intermediary corrective action plans as directed. Provides guidance to field
organization in billing audit process, the delivery of care and interpretation of agency policies
concerning state specific regulations and requirements.
• Responsible for state specific research of home health agency regulations, discipline practice
acts and guidelines required for state funded provider programs as requested. Triages and
prioritizes revisions to state specific policies.
• Travels onsite for consultation, education and training as appropriate.
• Adheres to and participates in Company’s mandatory HIPAA privacy program/practices and
Business Ethics and Compliance programs/practices.
• Reviews and adheres to all Company policies and procedures and the Employee Handbook.
• Participates in special projects and performs other duties as assigned.
• Bachelor’s degree in Nursing or the equivalent plus a minimum of five years clinical
experience including two years in home care environment generally required.
• Current RN licensure in the state of practice plus strong knowledge of home health
• A thorough knowledge of the home care industry, Medicare coverage requirements,
clinical and operations practices in home care, analytical ability, and a broad
understanding of federal and state regulatory requirements are required.
• Excellent interpersonal and communication skills, assertiveness and ability to travel are
• Strong organizational skills that reflect ability to perform and prioritize multiple tasks
seamlessly with excellent attention to detail.
• Intermediate to advanced experience with Microsoft Office: Word, Excel, Powerpoint,
• Possess excellent communication, organizational, and follow through skills.
• Proven track record of meeting deadlines and taking initiative to make rational decisions
under pressure while maintaining exceptional communication skills and a professional
Requisition ID: R0008128