Hospice Quality Assurance Specialist

Singh Management Co., Llc; West Bloomfield Charter Township (MI); Sur place; USD 75 000 - 110 000; Plein temps

Résumé du poste

DeKalb Health seeks a Hospice QA professional to conduct concurrent, pre-billing, and retrospective reviews of hospice and home health records to ensure medical necessity and Medicare compliance. You will evaluate eligibility, documentation quality, and LCD criteria when applicable, supporting timely, accurate submissions.

The role requires strong knowledge of CoPs, ability to identify issues before claims submission, and effective communication to educate clinical staff.

Qualifications

• Minimum 2 years of hospice clinical, QA, compliance, utilization review, or documentation-review experience.
• Strong knowledge of Medicare hospice CoPs and certification/recertification requirements.
• Ability to identify documentation deficiencies and reimbursement risks before claim submission.

Responsabilités

• Conduct concurrent, pre-billing, and retrospective review of hospice and home health clinical records to ensure completeness, accuracy, consistency, medical necessity, and compliance with Medicare requirements and agency standards.
• Perform hospice eligibility and recertification reviews, evaluating documentation for evidence of terminal decline, appropriate diagnoses, and LCD criteria when applicable.
• Coordinate and perform clinical record review for ADRs, TPE, post-payment reviews, denials, and appeals; assist with complete, organized, and defensible submissions within deadlines.
• Review hospice documentation for consistency across CTI, face-to-face encounters, assessments, plans of care, IDG documentation, and physician notes; educate staff when corrective action is needed.
• Review home health records for completeness, accuracy, medical necessity, and OASIS consistency; support quality improvement activities.
• Assign and validate ICD-10-CM codes and serve as a resource for staff on hospice eligibility and Medicare compliance.
• Collaborate with leadership to identify audit trends, implement corrective actions, and support regulatory readiness; perform field visits and weekend rotation as needed.

Connaissances

Hospice QA

Medicare CoPs

Documentation review

Compliance

Clinical judgment

Education/feedback

Description du poste

DeKalb Health seeks a Hospice QA professional to conduct concurrent, pre-billing, and retrospective reviews of hospice and home health records to ensure medical necessity and Medicare compliance. You will evaluate eligibility, documentation quality, and LCD criteria when applicable, supporting timely, accurate submissions.

The role requires strong knowledge of CoPs, ability to identify issues before claims submission, and effective communication to educate clinical staff.