Clinical Documentation Review Team Lead

Role Overview

• 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