Home Health QA Specialist

Nestmed; Oregon; Hybrid; USD 34,000 - 55,000; Full time

Job summary

Nestmed is hiring a QA Specialist to review Home Health charts, validate ICD-10-CM coding, and ensure OASIS guidance accuracy in an AI-enabled workflow. You will prioritize AI routing queues, maintain clinical documentation standards, and escalate unclear cases while maintaining HIPAA compliance.

Remote position within the United States, with emphasis on accuracy, timely reviews, and collaboration with clients to uphold CMS guidelines and payer requirements.

Qualifications

• Real home health chart review experience — you know what a comprehensive assessment, a physician's note, and a therapy record are supposed to say, and you notice when they don't agree
• Active or in-progress OASIS certification — HCS-O, COS-C, or another Nestmed-approved credential (in-progress is fine if you're working toward it on a defined timeline)
• A current, applicable ICD-10-CM coding credential, HCS-D, BCHH-C, CPC, RHIT
• Comfort working inside an AI-assisted workflow: critical enough to catch what the model misses, not so skeptical you ignore what it gets right
• Writing tight enough that a QA comment doesn't need a follow-up conversation
• The discipline to escalation instead of guess when a chart doesn't clearly support an answer

Responsibilities

• Complete assigned Home Health reviews accurately, timely, and in alignment with company standards, client expectations, ICD-10-CM coding guidelines, OASIS guidance, payer requirements, AI supported workflow expectations, and internal quality protocols.
• Own your queue. Complete assigned Home Health reviews against your quota, prioritizing AI routing queues, holds, and anything management flags as urgent — within turnaround time, with delays or access issues flagged the moment you spot them.
• Validate the coding. Check ICD-10-CM accuracy, sequencing, specificity, and guideline compliance: primary and secondary diagnoses, symptom and manifestation codes, etiology/manifestation pairing, laterality, encounter type, and whether the documentation actually backs up what's been coded.
• Hold OASIS to the record. Confirm every OASIS response is clinically supported, internally consistent, and matches CMS guidance — cross-referencing the comprehensive assessment, referral, physician documentation, therapy notes, wound care, medications, and hospital records. No copy-forward answers.
• Know where the risk lives. Focus on GG items and functional status, M1800 ADLs, cognition, pain, dyspnea, falls, wounds, medication management, hospitalization risk, and discharge disposition.
• Flag what's missing, clearly. When documentation is incomplete, unsigned, unclear, or contradictory, put the chart on hold or elevate it with actionable QA notes.
• Push back on the AI, then feed it forward. Review AI-generated coding, OASIS, and documentation suggestions with your clinical judgment and report patterns.
• Keep the record airtight. Maintain HIPAA compliance and confidentiality and manage certifications and tracking.

Skills

Home health chart review

OASIS certification

ICD-10-CM credential

AI-assisted workflow

Technical writing

Escalation discipline

Job description

Nestmed is building the AI-native operating system for post-acute care.Millions of Americans get care at home every year. The agencies delivering it run on decades-old software, disconnected tools, phone calls, and faxes, with nothing that ties the work together.We started with the hardest piece: understanding what actually happens in the visit. Now we're building everything on top of it, so an entire agency runs on one intelligent system.7 of the 10 largest home health companies in the US already run on Nestmed, across hundreds of thousands of visits a day. We closed our Series A, backed by investors including Max Levchin, co-founder of PayPal, and veterans of the home care industry.Location: Remote (U.S.)Role type: Hourly contract (part time/full time)Are you a detail oriented home health medical coding reviewer? Are you passionate about ICD-10 coding and OASIS? If yes, this is the role for you!

The Role

You will be responsible for completing assigned Home Health QA reviews accurately, timely, and in alignment with company standards, client expectations, ICD-10-CM coding guidelines, OASIS guidance, payer requirements, AI supported workflow expectations, and internal quality protocols. The QA Specialist is expected to demonstrate strong clinical documentation review skills, maintain applicable certifications, support accurate OASIS outcomes, and work effectively in an AI enabled review environment.

Own your queue. Complete assigned Home Health reviews against your quota, prioritizing AI routing queues, holds, and anything management flags as urgent — within turnaround time, with delays or access issues flagged the moment you spot them.

Validate the coding. Check ICD-10-CM accuracy, sequencing, specificity, and guideline compliance: primary and secondary diagnoses, symptom and manifestation codes, etiology/manifestation pairing, laterality, encounter type, and whether the documentation actually backs up what's been coded.

Hold OASIS to the record. Confirm every OASIS response is clinically supported, internally consistent, and matches CMS guidance — cross-referencing the comprehensive assessment, referral, physician documentation, therapy notes, wound care, medications, and hospital records. No copy-forward answers.

Know where the risk lives. Give the closest attention to the items that move outcomes: GG items and functional status, M1800 ADLs, cognition, pain, dyspnea, falls, wounds, medication management, hospitalization risk, and discharge disposition.

Flag what's missing, clearly. When documentation is incomplete, unsigned, unclear, or contradictory, put the chart on hold or elevate it — and write the QA comment specific enough that a coder, clinician, or client can act on it without calling you to ask what you meant.

Push back on the AI, then feed it forward. Review AI-generated coding, OASIS, and documentation suggestions with your own clinical judgment instead of deferring to them. When you spot a pattern — recurring errors, missed cues, a gap in the workflow — report it through the approved channel; your corrections are training data.

Keep the record airtight. Maintain HIPAA compliance and confidentiality across patient, client, and AI workflow data, and stay on top of the tracking, hold notes, and certification paperwork the role requires — including telling management immediately if a certification lapses.

Keep improving. Maintain your quality score, take secondary review and audit feedback without defensiveness, and show up for the training and calibration sessions that keep the team's interpretation consistent.

What You'll Bring

• Real home health chart review experience — you know what a comprehensive assessment, a physician's note, and a therapy record are supposed to say, and you notice when they don't agree
• Active or in-progress OASIS certification — HCS-O, COS-C, or another Nestmed-approved credential (in-progress is fine if you're working toward it on a defined timeline)
• A current, applicable ICD-10-CM coding credential, HCS-D, BCHH-C, CPC, RHIT
• Comfort working inside an AI-assisted workflow: critical enough to catch what the model misses, not so skeptical you ignore what it gets right
• Writing tight enough that a QA comment doesn't need a follow-up conversation
• The discipline to escalation instead of guess when a chart doesn't clearly support an answer

Certification Expectations

OASIS HCS-O, COS-C, or another company-approved OASIS certification. May be required at hire or obtained within a management-approved timeframe.

Coding Current applicable coding credential, per company standards and client scope.

Interview Process

• Knowledge check quiz/assignment
• Call with our Recruiter
• Final Round with Hiring Manager!

If you want to build the system an entire healthcare industry runs on, we'd love to hear from you.