Home Health Quality Assuranc / Coding Specialist

Job Description

Job Description

job Title

Home Health Quality Assurance (QA) / Coding Specialist

Department

Clinical Operations

Reports To

Director of Nursing (DON) / Clinical Manager

Position Summary

The Home Health Quality Assurance (QA) / Coding Specialist is responsible for reviewing clinical documentation to ensure compliance with Medicare Conditions of Participation (CoPs), state and federal regulations, and agency policies. This position performs ICD-10 coding, OASIS review, chart audits, and quality assurance activities to support accurate reimbursement, regulatory compliance, and high-quality patient care.

Essential Duties and Responsibilities

Quality Assurance

• 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.

Coding Responsibilities

• 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.

OASIS Review

• 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.

Compliance & Education

• 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.

Documentation Management

• 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.

Qualifications

• Current LVN or RN license preferred but not required, depending on agency needs.

• Certified Home Health Coding Specialist (HCS-D), COS-C, or equivalent certification preferred.

• Minimum of two (2) years of home health experience.

• Minimum of one (1) year of ICD-10 coding and OASIS review experience preferred.

• Thorough knowledge of Medicare Conditions of Participation and home health regulations.

• Strong understanding of ICD-10-CM coding guidelines.

• Experience with electronic medical record (EMR) systems.

• Excellent organizational, analytical, and problem-solving skills.

• Strong written and verbal communication skills.

• Ability to work independently while managing multiple priorities.

Knowledge, Skills, and Abilities

• Knowledge of Medicare reimbursement methodologies (PDGM).

• Proficiency in OASIS-E documentation and CMS regulations.

• Ability to identify documentation deficiencies and recommend corrective actions.

• Strong attention to detail and accuracy.

• Excellent time management and organizational skills.

• Ability to maintain strict confidentiality.

• Proficiency in Microsoft Office applications and EMR software.

Physical Requirements

• Prolonged periods of sitting and computer use.

• Ability to lift up to 20 pounds occasionally.

• Ability to communicate effectively by phone, video conference, and in person.

Work Environment

• Office-based position with the possibility of remote or hybrid work, depending on agency policy.

• Standard business hours with occasional overtime during audit periods or regulatory deadlines.

Performance Expectations

• Maintain high coding accuracy and documentation quality.

• Ensure timely completion of chart reviews and coding assignments.

• Support agency compliance with all Medicare and state regulations.

• Contribute to improved patient outcomes and successful survey results through continuous quality improvement efforts.