Initial onboarding will take place at our offices in Colchester, VT. The position will then be a hybrid work arrangement with 1-2 days per week in our offices located in Colchester, VT. In-person meetings are also required at least quarterly.

Job Summary

The Clinical RN Auditor is responsible for ensuring clinical documentation meets regulatory standards and procedures. This role involves reviewing potential quality of care issues, understanding workflows, and establishing patient care plans to support technical and clinical requirements. The auditor works to improve clinical outcomes by monitoring documentation accuracy and consistency, reducing risk, evaluating data, and collaborating with the manager of clinical outcomes to provide expertise in coding classifications.

Qualifications / Job Requirements

Education and Licensure

Current unencumbered Vermont RN Licensure
Homecare Coding Specialist- Diagnosis, or ability to obtain within one year from hire and maintained throughout employment
Homecare Coding Specialist- OASIS, or ability to obtain within one year from hire and maintain throughout employment
Associates Degree required, Bachelor’s degree preferred

Expected Experience/Skills/Attributes

3-5 Years of Home Health or Hospice experience; or a combination of education and experience from which comparable knowledge was obtained
Prior ICD-10 and other medical coding experience preferred
OASIS and HIS experience highly preferred
Proficiency in medical and clinical terminology
Demonstrated Proficiency in EMR (EHR) technology
Strong interpersonal and communication skills, with the ability to build and maintain relationships with diverse groups of people.
Excellent organizational and time management abilities
Meticulous and exacting attention to detail and trend identification
Strong project management abilities

Success Criteria

Quality Orientation – Comprehends and can explain technical and professional terminology, applies these skills appropriately and leverages these skills to solve difficult issues and identify opportunities for improvement to ensure accuracy and optimal outcomes.
Applied Reasoning – Leverage facts, data, and ideas to understand identifying interconnections and relevant themes; identifies underlying cause-and-effect relationships that may drive multiple, seemingly unrelated, outcomes.
High-Impact Communication – Conveys a professional presence in communication; clearly and succinctly conveying information and ideas. Checks understanding with audience adjusting message as necessary to ensure full comprehension.
Authenticity – Adheres to moral, ethical, and professional standards, regulations, and organizational policies; keeps commitments to promised actions.
Adaptability - Maintaining effectiveness when experiencing major changes in work responsibilities or environment (e.g., people, processes, structure, or culture); adjusting effectively to change by exploring the benefits, trying new approaches, and collaborating with others to make the change successful.

General Standards

Must demonstrate and maintain any required competency
Able to speak, read and write in English
Be honest, self-directed, possess initiative, display good judgment and a positive attitude toward daily activities
Have the ability to communicate clearly and effectively both orally and in written work
Be able to work cooperatively and in a productive manner with organization’s employees, clients, customers and the general public
Maintain satisfactory standing with the Adult Abuse Registry, Child Abuse & Neglect Registry, Vermont Criminal Information Center and OIG
Be free from intoxicating or impairing effects of drugs, prescribed or otherwise, in the workplace
Be free from the use of alcohol during work shifts
Be able to conduct the functions of this job without risk of harm to the health and safety of self and others
Hold a valid driver’s license and have a reliable, registered vehicle with insurance as required by the organization, and appropriate to position

Responsibilities

Conduct thorough audits of patient episodes of care, ensuring accurate documentation that meets Medicare Conditions of Participation while validating compliance with standards for all billing requirements. This includes identifying documentation inconsistencies and identifying opportunities for improved efficiency and accuracy.
Applies knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to determine the appropriate assignment of diagnosis codes and makes corrections while collaborating with stakeholders and reference tools. This includes seeking clarification from clinicians, physicians and others as needed to complete coding and OASIS reviews and initiating physician coding queries.
Supports monitoring of outcomes data, to ensure clinical proficiency maximizing outcomes and collaborates with the manager of clinical outcomes to provide remediation as needed. Analyze data to identify trends and opportunities for organizational accuracy and effectiveness.
Collaborate with manager and organizational stakeholders in order to maximize organizational reimbursement through ensuring the highest standard of quality and value-driven patient care.
Completes all duties also associated with Clinical Coder/Auditor roles which do not require an RN Licensure.

Professional Accountability

Demonstrates a commitment to the mission and values of the organization
Complies with all organization policies and procedures
Demonstrates respectful and effective communication in all interactions
Protects the privacy and confidentiality of clients, co-workers and organization’s operations
Complies with organization’s policies to protect confidentiality, integrity, availability and security of all protected health information
Conducts themself in a safe manner by adhering to all safety practices, rules and standards
Demonstrates a commitment to quality and proactively seeks to make improvements to systems and processes
Reports to work on time, provides advance notice for time off, accurately reports time and attendance and appropriately manages paid time off (if applicable) in accordance with organization’s policy
Demonstrates a commitment to integrity in work habits and use of organization’s resources
Performs duties as assigned that may be outside principle responsibilities
Meets own learning needs. Participates in educational programs of the organization, including completion of all mandatory competencies, education or training
Effectively communicates to transfer information, provide guidance and resolve conflicts
Reports concerns and complaints regarding abuse, neglect and exploitation in accordance with Vermont State Law and the organization
Enhance or improve organization’s services by participating in team meetings, projects and committees
Contributes to a positive work environment and responds in a constructive manner to change
Documents the provision care and services in accordance with organization’s policy

Work Conditions

1. Traveling may be required
2. May be asked to work during non-business hours
4. May experience:
Stress due to a demanding profession.
Extended periods of time working with computers

Essential Physical Requirements

1. Must walk, sit, stand, bend, lift and move intermittently during working hours
2. Must have the ability to push, pull and lift from the floor, up to a total of 50 pounds and be able to move with the weight, as to organization’s standards
3. Climbing-be able to navigate stairs of varying heights and degrees
4. Balancing-be able to maintain balance
5. Kneeling, crouching, stooping, twisting, reaching below waist level, reaching overhead and reaching torso level
6. Manual finger dexterity-will need dexterity to perform duties and use equipment
7. Visual acuity-will need sufficient eyesight to drive a car, use office equipment and perform duties
8. Auditory acuity- will need to assist individuals in person and by telephone

UVM Health - Home Health & Hospice

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