Responsibilities

• Perform documentation review on medical records to identify clinical elements for accuracy 

• Perform post-acute home health and or hospice documentation review on medical records to identify clinical elements for accuracy

• Research and provide comments and recommendations on complex or newly issues home health and or hospice billing regulations

• Review client information systems for complete and accurate clinical documentation  

• Research and provide comments and recommendations on complex or newly issued billing regulations 

• Conduct weekly calls with the client to present findings and results of the engagement 

• Analyze trends and provide process improvement recommendations for clinical operational processes to improve quality of care and patient outcomes 

• Review documentation associated with focused medical reviews and write appeals for denied services; provide denial support at the Administrative Law Judge (ALJ) level of appeals 

• Participate in cross-team clinical consulting work 

Qualifications

Required

• Associate’s Degree in nursing, social work, physical therapy or another related discipline 

• Active and unrestricted license in related field  

• At least 5 years of progressive post acute clinical management experience in home health and /or hospice

• Experience with case management in home health and/or hospice with progressive involvement in Quality Assurance activities

• In-depth knowledge of condition of participations and conditions of payment; extensive knowledge of regulatory standardized assessment documents and patient care protocols 

• Proficient in Microsoft Office Suite including Excel, PowerPoint, and Word 

• Excellent written and verbal communication and presentation skills are required 

Preferred

• Bachelor of Science in nursing (BSN), social work (MSW), physical therapy or another related discipline

• Experience with Medicare contractor audits and appeals

Expectations

• Comfortable with remote work arrangements and virtual collaboration tools  

• Physical demands include extended periods of sitting, computer use, and telephone communication 

• Position at times may include extended or irregular hours outside of traditional office hours to support clients and projects across multiple time zones  

• Travel up to 25% as needed 

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

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All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

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