Remote Home Health QA & Coding Specialist

GREEN MEADOWS HOME HEALTH CARE INC

Santa Ana (CA)

Hybrid

USD 70,000 - 90,000

Full time

14 days+

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Job summary

GREEN MEADOWS HOME HEALTH CARE INC seeks a Home Health Quality Assurance (QA) / Coding Specialist to review clinical documentation for compliance with Medicare CoPs, state and federal regulations, and agency policies. This role performs ICD-10 coding, OASIS review, chart audits, and quality assurance to support accurate reimbursement and high-quality patient care.

The candidate will collaborate with clinicians, stay current with coding updates, and guide documentation improvements, contributing

Qualifications

Current LVN or RN license preferred but not required, depending on agency needs.
Certified Home Health Coding Specialist (HCS-D) or COS-C certification preferred.
Minimum of two years of home health experience.
Minimum of one year of ICD-10 coding and OASIS review experience preferred.
Strong knowledge of Medicare Conditions of Participation and home health regulations.
Proficiency in EMR systems.

Responsibilities

Review all patient records for completeness, accuracy, and regulatory compliance before billing.
Conduct pre-bill and post-bill chart audits to ensure documentation supports skilled services provided.
Ensure compliance with Medicare, Medi-Cal, CMS, ACHC/JCAHO (if applicable), and agency policies.
Monitor documentation for timeliness, physician orders, signatures, and required certifications.
Identify documentation deficiencies and communicate necessary corrections to clinical staff.
Track quality indicators and assist with agency Quality Assessment and Performance Improvement (QAPI) initiatives.
Maintain audit logs and quality improvement reports.
Assign accurate ICD-10-CM diagnosis codes based on physician documentation and clinical records.
Review and validate primary and secondary diagnoses to ensure appropriate reimbursement.
Verify coding accuracy for OASIS assessments and Plans of Care.
Stay current with ICD-10 coding updates and CMS reimbursement guidelines.
Collaborate with clinicians to clarify diagnoses and improve documentation specificity.
Review Start of Care (SOC), Resumption of Care (ROC), Recertification, Transfer, Discharge, and Follow-Up OASIS assessments.
Validate OASIS accuracy, consistency, and regulatory compliance.
Ensure OASIS submissions are completed within CMS-required timeframes.
Provide education and feedback to clinicians regarding OASIS documentation and scoring.
Monitor agency compliance with Medicare Conditions of Participation.
Assist in preparing documentation for surveys, audits, and accreditation reviews.
Provide education and guidance to clinicians regarding documentation standards, coding updates, and regulatory changes.
Participate in quality improvement meetings and interdisciplinary team discussions.
Review physician orders, face-to-face documentation, certifications, recertifications, and plan of care documentation.
Ensure documentation supports medical necessity and homebound status.
Verify all required documentation is complete prior to claim submission.
Maintain confidentiality in accordance with HIPAA regulations.