Remote Home Health QA Specialist: ICD-10/OASIS

Nestmed, Inc.; 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 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.