Full job description

Seeking a nurse for an Audit and Utilization Review position with Smoky Mountain Home Health and Hospice in Newport, TN; for the purpose of quality control of charting, coding and chart audits. Smoky Mountain is a locally owned home health and hospice company with 7 offices providing care to patients across 13 East Tennessee counties.

Key Responsibilities
Review medical records within the time limit set by the Supervisor.
Send back correspondence to the field staff as required for corrections.
Maintain a daily system of providing timely and accurate information required for billing and/or regulation purposes.
Participate in on-call when needed.
Utilize Medicare/Medicaid and Private Insurance guidelines when auditing.
Prepare and/or review transfer summaries on Agency transferred patients entering a hospital, nursing home or other agency within stated timeframes.
Prepare and/or review admission, 60-90 day and discharge audits on assigned patients.
Keeps ongoing contact with patient care staff and orients/teaches as needed with the assistance of the Staff Education Coordinator and Supervisor. Able to communicate effectively.
Prepares and/or reviews chart information for additional data requisitions, denials and reconsiderations from Intermediary or any other agency asking for information as assigned by the Supervisor per SMHH&H policies (may include attorneys, family members, insurance companies, DHS, APS).

Qualifications
A Registered Professional or Licensed Nurse, currently licensed in Tennessee.
Have good working knowledge or be able to attain a good working knowledge of chart audits, Medicare and Medicaid guidelines as it pertains to Home Health care, Hospice care and coding.
Good working knowledge of Home Health and Hospice documentation.
Certification: Home Care Coding Specialist-Diagnosis (HCS-D)
Certification: Home Care Coding Specialist-Hospice (HCS-H)

Skills & Competencies
Strong clinical assessment and critical thinking skills
Excellent communication and interpersonal abilities
Ability to work independently and manage time effectively
Compassionate, patient-centered approach to care
Knowledge of home health and hospice regulations (Medicare/Medicaid)

Work Environment
Patient homes and community settings
Frequent travel required within service area
Flexible schedule, including evenings, weekends, and on-call shifts

Physical Requirements
Ability to lift/move patients (with assistance as needed)
Prolonged standing, walking, and driving
Ability to perform hands-on patient care tasksJob Type: Full-time
Benefits:
401(k)
Dental insurance
Disability insurance
Employee assistance program
Health insurance
Life insurance
Vision insurance
Education:
Associate (Required)
Experience:
Coding: 1 year (Preferred)
License/Certification:
RN License (Required)
Location: Newport, TN 37821 (Required)
Work Location: In person

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