Clinical Reviewer

LHH Recruitment Solutions is searching for a full-time Clinical Reviewer for Skilled Home Health on a contract basis for a client. Our client is seeking a dedicated Clinical Reviewer with clinical expertise in skilled home health to assist with the medical record review of Home Health claims following an Additional Documentation Request (ADR). The role involves organizing medical records into a review-friendly format and ensuring compliance with CMS requirements before submission. The ideal candidate will have experience in clinical documentation review, home health regulations, and possess strong organizational and communication skills.

Responsibilities:

• Perform comprehensive reviews of client medical records in accordance with the scope of work.
• Create or organize PDF/scanned medical record packets for ADR submission.
• Use ADOBE PRO licensed software to highlight key elements for CMS review.
• Verify all ADR-requested items are present and ensure completeness prior to client submission.
• Write cover letter summaries based on provided templates.
• Handle a volume of 5-7 ADR packets per day (minimum of 25-35 per week per FTE).
• Conduct weekly calls with clients to present findings and results of reviews.
• Provide recommendations on complex or newly issued billing regulations.
• Offer process improvement suggestions to enhance clinical operations, quality of care, and patient outcomes.
• Write appeals for denied services as needed and provide denial support at the ALJ level of appeals.
• Collaborate with cross-functional clinical consulting teams to deliver the best results for clients.
  
  

Required Qualifications:

• Associate degree in Nursing, Social Work, Physical Therapy, or a related discipline, or equivalent relevant work experience.
• Active professional license in a related field.
• A minimum of 5 years of progressive clinical management experience.
• At least 2 years of experience in quality assurance and/or case management.
• In-depth knowledge of Conditions of Participation and Conditions of Payment.
• Extensive knowledge of regulatory standardized assessment documents and patient care protocols.
• Proficiency in Microsoft Outlook, Excel, Word, and PowerPoint.
• Excellent written and oral communication and presentation skills.
  
  

Preferred Qualification:

• Bachelor of Science in Nursing (BSN), Social Work, Physical Therapy, or another related discipline.
  
  

Location: Remote

Pay:$36-$50/hr, DOE

Schedule: Mon- Fri, Full Time

Type: Contract

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

Pay Details: $36.00 to $50.00 per hour

Search managed by: Diana Bielawska

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

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The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.