Senior Quality Reviewer Jobs

Proficient computer skills, including working knowledge of Microsoft Office Suite.

Tuition Reimbursement & Professional Qualification benefits.

Perform reviews pursuant to the requirements of the SRA including but not limited to Appendix IV reviews.

Pharmacy benefits with mail order options.

Dental benefits including orthodontia benefits for adults and children.

Company-paid Life & AD&D benefits, including the option to purchase Supplemental life coverage for employee, spouse & children.

Position is responsible for review of clinical documentation of home care clinicians after admissions, recertifications, resumptions of care and discharge.

Minimum of 3 years of certified home care experience

Experience in OASIS review and coding highly desirable

Utilize decision software to assure OASIS assessment is completed accurately

Follows PDGM guidelines regarding coding with accuracy

Coach clinical staff on documentation accuracy

Mentors and trains less experienced staff and complete special assignments as requested by management. Assists staff with complex questions and issues.

Must have strong organizational and analytical abilities and effective interpersonal skills.

This role does not manage people

Must have knowledge in the processes and produces (i.e., claims processing and/or enrollment coding) is required

Must demonstrate verbal and communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.

Must have working knowledge about plan products, company initiatives and other operational changes affecting the department.