Home Health QA Specialist
New
N
NestmedHome Healthcare
Remote (U.S.), Eastern or Central Standard TimeContractMiddle
Salary22 - 25 USD per hour
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Job Details
Requirements
- Proven experience in home health chart review.
- Active or in-progress OASIS certification (e.g., HCS-O, COS-C, or other company-approved credential).
- Current applicable ICD-10-CM coding credential (e.g., HCS-D, BCHH-C, CPC, RHIT).
- Ability to work effectively in an AI-assisted review environment with strong clinical judgment.
- Strong attention to detail with the ability to identify discrepancies across clinical documents.
- Clear, concise written communication skills for QA comments.
- Discipline to escalate questions or concerns when documentation is unclear.
- Willingness to participate in training and calibration sessions for consistent quality.
Responsibilities
- Complete assigned Home Health reviews within turnaround time, prioritizing AI routing queues, holds, and urgent tasks.
- Validate ICD-10-CM accuracy, including primary and secondary diagnoses, sequencing, specificity, and guideline compliance.
- Confirm OASIS responses are clinically supported and match CMS guidance by cross-referencing comprehensive assessments, therapy notes, and medical records.
- Identify risks in key outcome items such as GG items, ADLs, cognition, pain, dyspnea, and wound care.
- Flag incomplete or contradictory documentation and provide clear, actionable QA comments for clinicians or coders.
- Review and correct AI-generated coding and documentation suggestions, reporting patterns or workflow gaps.
- Maintain HIPAA compliance and keep documentation, hold notes, and certification paperwork up to date.
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