Nurse Auditor II, Home Health

At UK King's Daughters, we’re not just a healthcare facility — we’re a family of dedicated professionals who share a passion for making a meaningful difference in the lives of our patients. We’re more than just a place to work; we’re a place to grow, thrive, and contribute to our community.

Job Description:

Job Summary

Conducts thorough reviews of medical records to support accurate charge capture and billing for home health services. Identifies and reports documentation discrepancies to management for educational improvement. Ensures optimal and quality charge entry for all billable home health patient services. Collaborates with clinical and administrative teams to maintain high standards of documentation and billing accuracy.

Essential Functions

• Reviews OASIS data and utilizes SHP alerts and validation reports to ensure accuracy.

• Applies knowledge of CMS Conditions of Participation and follows procedures to maintain compliance with legal and regulatory requirements.

• Ensures appropriate ICD-10 coding and sequencing based on patient medical conditions and co-morbidities.

• Consults with clinicians to clarify data integrity issues, documents corrections, and updates medical records as needed.

• Reviews visit utilization for appropriateness and reports potential financial losses or under-utilization to the Clinical Supervisor or designee.

• Notifies agency leadership of problematic trends in OASIS documentation and works with the clinical manager to address outcome measures.

• Assists with chart audits, monitors open and closed charts, and participates in quarterly clinical record reviews.

• Supports quality improvement teams with data collection and participates in quality assessment processes for continuous improvement.

• Performs other duties as assigned.

Education Requirement

Bachelor’s degree in nursing, healthcare administration, or a related field

Master’s degree in nursing, healthcare administration, or a related field is preferred

Experience Requirement

2-3 years of experience in home health auditing, clinical review, or a relevant area

An equivalent combination of education and experience may be considered.

All experience must be paid and in the same related field.

Part-time and PRN experience will be prorated based on hours worked per week.

Volunteer work and internships for academic credit are not counted.

Certifications & Licensures

Maintains active licensed Practical Nurse (LPN) license

Working Conditions

A. Lifting, pushing, and/or pulling objects up to 50lbs: 2. Occasional (< 10% of the time)

B. Lifting, pushing, and/or pulling objects over 50lbs: 1. Never

C. Standing or walking with objects up to 10lbs: 3. Intermittent (10% - 50% of the time)

D. Standing or walking with objects up to 25lbs: 2. Occasional (< 10% of the time)

E. Sitting at computer workstation for extended periods: 4. Regular (> 50% of the time)

F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials: 2. Occasional (< 10% of the time)

G. Repetitive motion: 4. Regular (> 50% of the time)

H. Working at heights above 4 feet: 1. Never

I. Working in confined spaces: 1. Never

J. Risk of injuries from use of equipment on the job: 2. Occasional (< 10% of the time)

K. Job-related travel: 3. Intermittent (10% - 50% of the time)

L. Loud noises: 1. Never

M. Temperature extremes: 2. Occasional (< 10% of the time)

N. Hazardous chemicals and fumes including waste: 2. Occasional (< 10% of the time)

O. Radiation: 1. Never

P. Burns: 1. Never

Q. Cuts/Punctures: 2. Occasional (< 10% of the time)

R. Bloodborne/airborne pathogens: 2. Occasional (< 10% of the time)

S. Recombinant DNA or viral vectors: 1. Never

T. Combative/violent people: 2. Occasional (< 10% of the time)

U. Animal handling (including carcasses): 1. Never

V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A

Physical Demands

This position requires regular sitting at a computer workstation for extended periods of time; regular performance of tasks with repetitive motions (such as typing or data entry); intermittent standing or walking with objects weighing up to 10 pounds; occasional standing or walking with objects weighing up to 25 pounds; and occasional lifting, pushing, and/or pulling of objects weighing up to 50 pounds. Also involves occasional risk of back injury from moving, lifting, or positioning patients, equipment, or materials; occasional risk of injuries from use of equipment on the job; occasional exposure to hazardous chemicals and fumes including waste, cuts/punctures, and bloodborne or airborne pathogens; occasional exposure to temperature extremes and combative or violent people; and intermittent job-related travel.

Additional Job Descriptions

N/A

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