Home Health Clinical QA & Intake Nurse (RN) - Remote | US Client

AdminEdge; Metro Manila; Remote; PHP 608,000 - 695,000; Full time

Benefits offered by this job

Fully remote

Fixed schedule aligned with PT

PTO 10 days + 6 holidays

Job summary

AdminEdge, a U.S.-based Medicare-certified home health agency, seeks an experienced RN to lead home health coding, OASIS QA, and intake support from the Philippines (remote, PST hours). The ideal candidate will independently review medical records, assign ICD-10-CM codes, ensure PDGM alignment, verify OASIS data, and collaborate with clinicians to uphold Medicare compliance and documentation quality.

This full-time, remote role offers a competitive hourly rate ($7–$8), a fixed schedule aligned

Qualifications

• Active RN license to practice in the U.S. Medicare setting.
• Minimum 3 years in Medicare home health coding or clinical QA.
• Proficient in ICD-10-CM, PDGM, and OASIS documentation.
• Ability to work Pacific Time hours; fully remote.

Responsibilities

• Perform ICD-10-CM coding for home health episodes and verify sequencing.
• QA review of OASIS assessments for accuracy and compliance.
• Review referrals and intake documentation for completeness.
• Collaborate with clinicians to resolve coding and documentation gaps.
• Maintain HIPAA compliance and accurate documentation practices.

Skills

RN licensure

Medicare coding

ICD-10-CM coding

PDGM

OASIS QA

EMR proficiency

AI-assisted coding

Education

Registered Nurse license

Tools

Axxess

WellSky

EMR systems

Job description

Position: Home Health Clinical QA & Intake Nurse (RN)

Job Type:Full-time (40 hours/week)

Location:Philippines (Remote, PST hours)

Salary: $7/hr – $8/hr

Overview

A U.S.-based, Medicare-certified home health agency is seeking an experienced Registered Nurse (RN) to manage home health diagnosis coding, OASIS quality assurance, clinical documentation review, and skilled home health intake support.

This is a hands‑on clinical role requiring strong expertise in Medicare home health ICD‑10‑CM coding, PDGM, OASIS assessments, and regulatory compliance. The successful candidate will independently review complex medical records, ensure accurate diagnosis coding and sequencing, identify documentation deficiencies, and collaborate with clinical teams to maintain high standards of patient care and documentation quality.

The role combines three core functions: home health diagnosis coding, OASIS and clinical documentation QA, and referral and intake support. Responsibilities will be allocated flexibly based on referral volume, patient census, documentation workload, and operational priorities.

We're looking for a highly competent home health coder with substantial OASIS QA experience, strong clinical judgment, excellent attention to detail, and the ability to independently resolve coding and documentation issues.

The ideal candidate is comfortable working with home health electronic medical record (EMR) systems and AI‑assisted workflows while maintaining independent responsibility for coding accuracy, clinical quality, and Medicare compliance.

Key Responsibilities

Home Health ICD-10-CM Coding & PDGM

• Independently assign, review, and validate ICD-10-CM diagnosis codes and sequencing for Medicare home health episodes.

• Determine appropriate primary and secondary diagnoses based on physician documentation, clinical findings, focus of care, and applicable coding guidelines.

• Apply current ICD-10-CM coding conventions, Medicare home health requirements, and Patient-Driven Groupings Model (PDGM) principles.

• Identify relevant comorbidities, complications, and additional diagnoses supported by clinical documentation.

• Review medical records for incomplete, conflicting, or insufficient information and obtain appropriate clarification before finalizing coding.

• Ensure consistency between coded diagnoses, OASIS assessments, physician orders, medical records, and plans of care.

• Identify and correct coding discrepancies, unsupported diagnoses, sequencing errors, and documentation specificity issues.

• Utilize AI-assisted coding tools while independently validating coding recommendations and maintaining compliance with coding standards.

• Collaborate with clinicians and clinical leadership to resolve complex coding questions and support coding audits, documentation improvements, and education initiatives.

• Maintain accurate, compliant coding practices without unsupported diagnosis assignments, upcoding, or reimbursement-driven documentation changes.

OASIS & Clinical Documentation Quality Assurance

• Perform comprehensive QA reviews of OASIS assessments, including start of care, resumption of care, recertification, transfer, and discharge assessments.

• Review clinical documentation for completeness, accuracy, consistency, medical necessity, and Medicare compliance.

• Cross‑reference OASIS responses with medical records, clinical assessments, diagnoses, wound documentation, medications, functional status, physician orders, and plans of care.

• Identify inconsistencies involving skilled need, homebound status, focus of care, visit frequencies, and ordered services.

• Verify documentation supporting Medicare face‑to‑face encounter requirements.

• Identify deficiencies in clinical reasoning, patient education, interventions, care coordination, and follow‑up documentation.

• Conduct independent clinical reviews following AI-assisted documentation screening.

• Communicate clear, actionable clarification requests to clinicians and follow outstanding documentation deficiencies through resolution.

• Escalate significant clinical, regulatory, or documentation concerns to clinical leadership.

• Identify recurring documentation errors and recommend improvements to clinical documentation quality and workflows.

• Preserve the integrity of field clinicians' original assessments without substituting remote judgment for findings requiring direct patient evaluation.

Skilled Home Health Referral & Intake Support

• Review incoming home health referrals, physician orders, discharge summaries, progress notes, and supporting medical records.

• Identify missing or conflicting diagnoses, incomplete physician orders, insufficient face‑to‑face documentation, and other potential admission barriers.

• Evaluate clinical documentation supporting skilled need, homebound status, and the appropriateness of requested home health services.

• Coordinate with intake personnel and clinicians to obtain missing medical records, clarify clinical information, and resolve documentation deficiencies.

• Ensure referral diagnoses and relevant clinical information are accurately communicated to admitting clinicians.

• Assist with referral processing, authorization requirements, and admission readiness.

• Identify and escalate potential start‑of‑care delays and support timely patient admission.

• Provide additional clinical intake and operational support based on agency priorities.

Clinical Coordination & Quality Improvement

• Collaborate with field clinicians, intake personnel, clinical managers, and physician leadership to resolve coding, documentation, and intake concerns.

• Provide constructive feedback to clinical teams regarding documentation deficiencies, coding inconsistencies, and opportunities for improvement.

• Maintain organized tracking of coding reviews, QA findings, clarification requests, and unresolved documentation issues.

• Identify recurring errors and recommend targeted education, process improvements, and workflow enhancements.

• Participate in clinical quality improvement initiatives and relevant team meetings.

• Help develop efficient workflows integrating referral intake, diagnosis coding, OASIS QA, and clinical documentation review.

• Support the implementation and optimization of home health EMR systems, including AI-assisted coding and documentation tools.

• Maintain HIPAA compliance and appropriate patient information security.

• Manage competing priorities while maintaining coding accuracy, documentation quality, and timely completion of assigned reviews.

Preferred Skills & Qualifications

• Registered Nurse (RN) with strong clinical knowledge and relevant licensure appropriate to assigned duties.

• Minimum 3 years of experience in U.S. Medicare-certified home health coding and/or clinical QA, including substantial hands‑on coding responsibility.

• Demonstrated ability to independently perform accurate home health ICD-10-CM diagnosis coding and sequencing.

• Strong working knowledge of PDGM, Medicare home health coding guidelines, and clinical documentation requirements.

• Substantial hands‑on experience reviewing OASIS assessments and clinical documentation for accuracy, completeness, and regulatory compliance.

• Strong understanding of skilled need, homebound status, face‑to‑face encounter requirements, physician orders, and plans of care.

• Ability to critically interpret complex medical records, identify unsupported diagnoses, and resolve coding or clinical documentation inconsistencies.

• Strong clinical judgment, analytical skills, and attention to detail, with the ability to independently identify and resolve documentation deficiencies.

• Excellent written and spoken English, including professional communication with U.S.-based clinicians, clinical managers, and administrative teams.

• Strong organizational, time management, and independent problem‑solving skills, with the ability to manage multiple priorities.

• Proficiency with home health EMR systems and willingness to learn new technology, including AI-supported clinical documentation and coding workflows.

• Availability to work full‑time during U.S. Pacific Time business hours.

Nice-to-Have (Bonus Skills)

• 5+ years of experience in Medicare-certified home health coding and clinical quality assurance.

• HCS-D certification (Home Care Coding Specialist – Diagnosis) or equivalent demonstrated home health coding expertise.

• OASIS certification, such as HCS-O or COS-C.

• Proven experience independently managing both home health diagnosis coding and OASIS QA.

• Experience reviewing skilled home health referrals and supporting clinical intake operations.

• Familiarity with Axxess, WellSky, or comparable home health EMR systems.

• Experience using AI-assisted coding or clinical documentation review tools.

• Experience conducting internal coding audits, identifying recurring documentation errors, and developing clinical documentation improvement processes.

• Experience supporting clinical quality improvement initiatives and optimizing workflows across coding, OASIS QA, and intake operations.

What we offer:

• Competitive compensation

• Fixed schedule aligned with U.S. Pacific Time business hours

• Fully remote role — work from anywhere

• Opportunity to work directly with a U.S.-based, physician-led home health clinical team

• Paid time off — 10 PTO days per year, plus 6 U.S. holidays off