Quality Assurance Specialist

So, you like working with a creative, dynamic team and making a difference? Sometimes the grass is greener! The mission of First Call Hospice, a locally owned agency founded in 1993, is to provide individualized quality hospice care to meet the unique needs of patients with a limited life expectancy. The primary goal of First Call Hospice is to enhance the quality of life when the quantity of life is limited. Rated one of Sacramento's 2024 Best Places to Work, First Call Hospice is growing and looking for experienced, compassionate Quality Assurance Specialist to join our team! JOB SUMMARY The Quality Assurance Specialist is responsible for analyzing data integrity and consistency of documentation and assessment processes. This position will ensure appropriate ICD-9 – ICD-10 coding and sequencing and will work with clinical staff to clarify documentation and data integrity issues. DUTIES & RESPONSIBILITIES Prospectively reviews all assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy. Ensures appropriate ICD-9 – ICD-10 coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities. Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections per organization policy. Reviews visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and/or underutilization to the clinical manager/designee. Notifies Quality Assurance and Agency Managers of problematic trends as a result of documentation review. Participates in Quality Improvement and Corporate Compliance activities as assigned. Assists with other chart audit activities as assigned. Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications. The above statements are only meant to be a representative summary of the major duties and responsibilities performed by the employee of this job. The employee may be requested to perform job-related tasks other than those stated in this description. JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities) Active California RN or LVN license required 1-2 years of experience of hospice clinical, coding, or billing experience required. Working knowledge of ICD-9/ICD-10 coding. Knowledge of federal regulations and state licensure requirements. Working knowledge of computer systems. Licensed driver with automobile that is in good working order and insured in accordance with organization requirements. Excellent coordination and communication skills. Detail oriented and able to work with minimal supervision Why First Call? First Call Hospice is part of the Cornerstone Group with close to 80 agencies throughout the country. While we are part of a large family, we operate as a local team. We understand we are nothing without great employees! It is through our team’s dedication to deliver life changing service that we become the “provider of choice” in the community that we serve. Join a culture of high performers who are on a mission to create the best agency in the Greater Sacramento Area! What makes us unique besides our culture of high performers and exceptional care? At First Call, we foster an environment where clinicians and staff members have an unprecedented level of freedom to create and implement the programs that will best serve their patients and communities. We operate with the Core Values of CAPLICO in mind: Celebration Accountability Passion for Learning Love One Another Intelligent Risk Taking Customer Second Ownership The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at http://www.pennantgroup.com.