Responsible for reviewing all Medicare, Medicaid and HMO client charts and files at the local level to assure proper documentation to maximize reimbursement. This review includes verification of appropriate documentation, quality of care provided, visit utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines. Audit charts to ensure completeness as per Medicare guidelines. Assist with quality assurance and Medicare compliance training programs. Develop reference materials to resolve inadequacies. Communicate with the Governing Body of notable situations requiring more extensive training or action. Monitor the receipt of denial notices. Assess the validity of these denials and respond with additional information. Inform the Governing Body of noticeable trends or relevant issues.
Bachelor’s Degree in Nursing or equivalent. Home Health experience is a plus. Two years experience as a QA nurse of a Medicare-certified home health agency preferred. A working knowledge of Medicare home health requirements. One year of supervisory experience preferred. Current and unrestricted Registered Nurse licensure in the state of Wisconsin & current CPR certification and valid driver’s license. Ability to set objectives and develop action plans. Good organizational, interpersonal and good judgment skills and the ability to handle sensitive issues and resolve difficulties not routine in nature