Responsible for activities associated with the receipt, processing, review and final determination of government inquiries and and denials and requests for clinical documentation. Government inquiries include, but are not limited to any and all pre and or post payment audits, such as: ADRs, CERTs, RACs, ZPICs, etc. Clinical documentation includes that which is associated with home health, hospice, and LTACHs.
LHC Group is the preferred post-acute care partner for hospitals, physicians and families nationwide. From home health and hospice care to long-term acute care and community-based services, we deliver high-quality, cost-effective care that empowers patients to manage their health at home. Hospitals and health systems around the country have partnered with LHC Group to deliver patient-centered care in the home. More hospitals, physicians and families choose LHC Group, because we are united by a single, shared purpose: It's all about helping people.
As noted by independent analysts, LHC Group consistently outperforms the industry in the percentage of our locations rating four stars or more. We are helping drive better outcomes for our patients nationwide.
Assist with the Implementation, coordination, monitoring and evaluation of the processes and procedures of the Governmental Audit Team.
* Assist with the centralized process for the receipt and review of government inquiries for clinical documentation, such as: ADRs, CERTs, RACs, ZPICs, etc.
* Maintains a standardized approach to clinical review that maximizes inter-rater reliability.
* Acts as a resource to Clinical Auditors during the review process.
* Is responsible and accountable for initial and if needed, final internal review determinations that establish the decision to
appeal any external audit denials.
* Assist with the managing of the appeal process of external review denials.
* Assist with the development and maintenance of statistical reporting of team activities, productivity, trends and outcomes
related to all government requests and their tracking.
*Maintains a current and working knowledge of relevant issues, laws and regulations through relevant websites, periodicals,
seminars, training programs, and peer contact. This includes state and Federal regulations governing compliance and reimbursement.
* Maintains current knowledge of relevant LHC Group policies and procedures related to Compliance, Performance Improvement,
Clinical Documentation, Internal Audit, etc
* Works with other LHC departments Directors and Managers to coordinate team s activities such that there is a minimum
disruption to day-to-day operations.
* Works with established LHC processes to communicate trends based on audit findings to promote organization-wide corrective
action and behavioral changes.
* Works with the Governmental Audit Supervisor to ensure government pay backs as determined through established audit process and procedure.
* Assist Governmental Audit Supervisor as needed with any additional Compliance Audits
* Performs other duties as assigned.
Formal Education: Bachelor's/Associate's Degree
Experience: 5 years
License, Registration, and / or Certification Requirement: Yes
* Degree in Nursing required.
* Minimum of one (1) to five (5) years experience in hospice, LTAC, and|or home health care, with current and working
knowledge of reimbursement and compliance rules and regulations.
* Current license and registration to practice as a licensed practical nurse or registered nurse preferred.
* Proficient skills in all Microsoft Office applications (Word, Excel, etc.).
* Evidence of leadership qualities and effective communication skills.
* Ability to relate and work well with others within each level of authority and responsibility.
* Ability to efficiently work independently.
* Strong critical thinking skills.
Associated topics: foreign affairs, government, legislative, policy, political science, politics, public affairs, rights