Clinical Documentation Review Team Lead
Pennant
full-time
Posted on:
Location Type: Remote
Location: Alabama • United States
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Job Level
About the role
- Conduct detailed home health and hospice pre-billing reviews to support Portfolio partners and their agencies.
- Identify discrepancies, missing information, and opportunities for documentation improvement.
- Utilize information gathered to provide education and facilitate alterations to the HCHB documentation, and process improvements to prevent recurrence.
- Direct agencies to use documentation data outcomes for QA improvements.
- Ensure documentation accurately reflects the patient’s clinical status and the care provided.
- Set up meetings with clinical leaders to provide education, highlight findings, and make documentation recommendations.
- Stay current with practices in both home health and hospice fields and suggest educational and resource materials which would be beneficial to the staff.
- Recommend new approaches to on-going continued improvements to policies, procedures, and documentation.
- Identify trending issues and share them with the team and the clinical leaders.
- Stay up to date with all federal, state, and local regulations, as well as organizational policies and procedures to ensure compliance.
- Work within and be comfortable with HCHB, PDF-Xchange, Excel, and Smartsheet.
- Consistently promote CAPLICO.
- Serve as the first point of escalation for documentation review questions.
- Provide real-time guidance on documentation standards, interpretation, and expectations.
- Reinforce consistency in review methodology across all reviewers.
- Hold team alignment meetings to discuss review findings and ensure standardization.
- Support onboarding and mentoring of new documentation reviewers.
- Identify training gaps and recommend targeted education.
- Monitor review quality and provide constructive feedback to promote defensible documentation practices.
- Track common documentation deficiencies and trends and share with leadership.
- Escalate systemic issues to the Director with recommended solutions.
- Assist with workload balance and prioritization when needed.
- Monitor turnaround times and flag potential deadline risks.
- Reinforce accountability while maintaining a positive and collaborative team culture.
Requirements
- Registered Nurse or related licensure highly preferred.
- Significant experience and knowledge of the Home Health and/or Hospice environment, typically gained by five or more years of industry-related experience.
- Strong knowledge of Medicare and Medicaid regulations.
- Demonstrated ability to interpret and apply CMS Conditions of Participation and Conditions of Payment.
- Prior documentation review, audit, or compliance experience preferred.
- Strong sense of autonomy and confidence when working independently while also functioning effectively as a team leader.
- Demonstrated ability to mentor and guide peers while maintaining collaborative relationships.
- Demonstrates initiative in researching and resolving issues.
- Able to discern areas in need of continued improvement.
- Detail and deadline oriented with the ability to prioritize and multitask.
- Able to adapt to a fast-paced environment and learn and retain new or evolving information and procedures.
- Able to collaborate with physicians and healthcare providers to clarify clinical documentation and obtain additional information when necessary.
- Flexible and responsive to changing business needs.
- Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, Smartsheet).
- Experience with HCHB required.
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
documentation reviewauditcomplianceinterpretation of CMS Conditions of Participationinterpretation of CMS Conditions of Paymentknowledge of Medicare regulationsknowledge of Medicaid regulationshome health experiencehospice experiencetraining and mentoring
Soft Skills
autonomyteam leadershipcollaborationinitiativedetail-orienteddeadline-orientedmultitaskingflexibilityproblem-solvingcommunication
Certifications
Registered Nurse licensure