The Medicare Case Manager/Coder provides support to all BAYADA Home Health Care Medicare service offices by monitoring Outcome and Assessment Information Set (OASIS) documentation for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to maintain ongoing communication with BAYADA’s service offices and assist the company in addressing and meeting business and development goals.

Responsibilities

  • Demonstrate and communicate the core values of BAYADA and The BAYADA Way.
  • Develop working knowledge of BAYADA’s mission, services, people, organization, policies, and procedures.
  • Be pleasant and exhibit poise and leadership in dealing with BAYADA field and office staff, clients, service offices, and support offices.
  • Oversee the management of Medicare and PPS model clients from referral through final billing.
  • Perform final review and lock OASIS.
  • Prevent or decrease the occasion of Medicare denials by assuring proper coding and documentation on the plan of care/485.
  • Review clinical information for appropriateness, congruency and accuracy as it relates to the OASIS and 485 while using the Medicare PDGM model and CMS guidelines.
  • Review and communicate OASIS edit information to each service office to promote OASIS accuracy.
  • Provide support and communication to all disciplines within the service office.
  • Provide customer service/education and act as a resource to Medicare Certified Offices with regards to CMS guidelines, Home Care Coding, PDGM guidelines and billing related issues.
  • Provide ongoing communication with service offices via e-mail, zoom, or telephone (specific to the service office needs).
  • Timely review and coding of OASIS documents with productivity maintained at the weekly target set by the Director of MCM.
  • Communication with service offices monthly and as appropriate with a focus on documentation trends, star ratings and potential process issues.

Qualifications

  • Exemplifies characteristics of The BAYADA Way: compassion, excellence and reliability.
  • Four (4) year college degree preferred.
  • COS-C or HCS-O OASIS Certification prior to hire.
  • HCS-D or BCHH-C Home Health Care Coding Certification prior to hire.
  • Minimum three (3) years of experience with OASIS and coding in the homecare setting.
  • Demonstrated record of strong interpersonal skills.
  • Competence in basic PC skills required to perform job functions.

 

Founded in 1975 by J. Mark Baiada, BAYADA Home Health Care provides nursing, rehabilitative, therapeutic, hospice, and assistive care services to children, adults, and seniors in the comfort of their homes. Headquartered in suburban Philadelphia, BAYADA employs more than 23,000 field and office professionals who serve their communities in over 20 states from more than 300 offices. BAYADA Home Health Care, Inc. is an Equal Opportunity Employer and qualified applicants will not be discriminated against on the basis of race, color, religion, sex, national origin, disability, or veteran status.

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