Clinical Documentation Specialist

Position Summary

The Clinical Documentation Specialist RN [Registered Nurse], is responsible for the quality review of all OASIS documents and review of key elements of the Plan of Care to ensure CMS program compliance is met. The Clinical Documentation Specialist works closely with the Manager of Quality Improvement and Home Health leadership to promote regulatory compliance and excellent patient outcomes and reimbursement. The Clinical Documentation Specialist serves as a role model and Oasis expert to Home Health staff across the region.

Providence at Home with Compassus

The Clinical Documentation Specialist RN [Registered Nurse], is responsible for the quality review of all OASIS documents and review of key elements of the Plan of Care to ensure CMS program compliance is met. The Clinical Documentation Specialist works closely with the Manager of Quality Improvement and Home Health leadership to promote regulatory compliance and excellent patient outcomes and reimbursement. The Clinical Documentation Specialist serves as a role model and Oasis expert to Home Health staff across the region.

• The job duties listed are essential functions of the position.
• However, other duties may be assigned, and may also be considered.
• essential functions of the position.
• The caregiver must be sufficiently fluent in the English language to satisfactorily perform the essential functions of the position.
• The.
• degree of fluency required will vary depending upon the nature of the position.
• Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies and.
• standards of their organization.
• For direct patient care roles:
  Performs and maintains currency of essential competencies as required by specific area of hire and.
• populations served.
• SERVICE:
• Promotes caregiver satisfaction by personal example, treating all contacts with respect.
• Supports and participates in activities that foster customer service.
• Communicates and follows the organizational chain of command for notification of patient care/service.
• issues, when appropriate.
• PEOPLE:
• Maintains required applicable licensure, certification and education.
• Attends and successfully completes general and department orientation, in-service programs and the.
• annual key competencies and mandatory update requirements.
• Participates actively in department staff meetings.
• Demonstrates effective verbal and written communications.
• Responsible for the timely review and processing of Start of Care, Resumption of Care, Recertification, and.
• Significant Change in Condition Home Health OASIS Assessment documents and key elements of the Plan of.
• Care.
• Proficiency as a Clinical Documentation Specialist includes the ability to perform Discharge OASIS Review.
• accurately.
• Collaborates with leadership to analyze performance trends in OASIS accuracy; assists in determining.
• learning needs for clinical staff.
• Educates and provides feedback to clinical staff in regards to correct completion of OASIS documents.
• Responsible for the review of all OASIS data items and ensures accuracy of OASIS based outcome.
• measures to reflect accurate Home Health Quality of Care Star rating and Value Based Purchasing OASIS.
• Based component of TPS.
• Ensures Regulatory compliance with all OASIS conventions.
• Ensures timely processing of all OASIS documents to meet CMS guidelines and CMS billing requirements.
• Work in a virtual team environment in a manner that promotes team cohesiveness, efficiency, and.
• productivity.
• Participates in team meetings, learning opportunities, and other educational opportunities as assigned.
• Demonstrates continuous learning of OASIS regulations and guidance to stay knowledgeable of current.
• guidance with demonstrated ability to apply guidance to OASIS Review.
• Achieves and maintains proficiency in OASIS Review including Discharge OASIS Review.
• Performs other duties as assigned.

• Required
  - Education to meet and maintain license requirements
• Required 2 years Clinical Experience as a Registered Nurse
• Required 1 year or Home Health Clinical Experience as a Registered Nurse
• Required 1 year Demonstrated proficiency in Home Health OASIS Review including all types of OASIS Required 3 months Experience with an Electronic Medical Record (EMR) system EXPERIENCE Required/Preferred Minimum Experience Details Preferred OASIS Certification Preferred 1 year OASIS Review Experience and 1 Year Home Health Clinical Experience

• Mathematical
  
  Skills:
  
  Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage.
• Language
  
  Skills:
  
  Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders,…