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 ( 50% of the time) F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials 2. Occasional ( 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 ( Apply To this Job