Quality Assurance and Coding Specialist - Home Health

Description

Quality Assurance and Coding Specialist - Shape Quality Across Home Health

Are you an experienced home health clinician with deep expertise in OASIS, ICD-10-CM coding, and clinical documentation? Do you enjoy turning complex regulations and performance data into practical guidance that helps clinicians succeed? Home Healthcare, Hospice and Community Services is seeking a Quality Assurance and Coding Specialist to strengthen documentation quality, support compliant reimbursement, and advance patient outcomes across our home health agency.

In this highly collaborative role, you will serve as a trusted resource to clinicians, Clinical Managers, Educators, and organizational leadership. Through auditing, education, coaching, and performance monitoring, you will help ensure accurate OASIS assessments, coding integrity, effective Plans of Care, and compliance with Medicare Conditions of Participation and other applicable requirements.

This position may be hybrid or fully remote based on operational needs.

Why Join Us?

At Home Healthcare, Hospice and Community Services, we believe our employees are at the heart of the care we provide. As our Quality Assurance and Coding Specialist, your expertise will influence clinical practice, strengthen agency performance, and help care teams deliver safe, effective, patient-centered care.

What We Offer

• Meaningful Impact: Improve documentation, quality outcomes, patient safety, and clinical excellence across the organization.
• Professional Collaboration: Partner with clinicians, managers, educators, interdisciplinary teams, and organizational leaders.
• Opportunities to Lead: Serve as a subject matter expert and help shape quality, compliance, coding, and educational initiatives.
• Flexible Work Arrangement: Work in a hybrid or fully remote setting based on operational needs.
• Professional Growth: Stay at the forefront of OASIS, coding, quality measurement, value-based purchasing, and regulatory requirements.
• Supportive Environment: Join a team committed to continuous improvement, accountability, and high-quality patient care.

Key Responsibilities

• Conduct pre-bill and post-bill clinical record audits for completeness, timeliness, medical necessity, coding accuracy, and regulatory compliance.
• Review Start of Care, Resumption of Care, Recertification, Follow-up, Transfer, and Discharge assessments for accuracy and consistency.
• Validate OASIS scoring and ensure assessments comply with current CMS guidance and accurately reflect each patient's clinical and functional status.
• Review, assign, sequence, and validate home health diagnoses using current ICD-10-CM coding guidelines, CMS regulations, and payer requirements.
• Ensure Plans of Care accurately reflect patient needs, diagnoses, interventions, goals, and anticipated outcomes.
• Collaborate with clinicians and providers to clarify diagnoses, strengthen supporting documentation, and resolve deficiencies that may delay billing.
• Serve as an agency subject matter expert on OASIS requirements, coding guidance, complex clinical scenarios, documentation standards, and regulatory updates.
• Develop and deliver OASIS, coding, and documentation education through orientation, case-based training, annual competencies, reference materials, and one-on-one coaching.
• Monitor clinician, team, branch, and agency performance trends and translate findings into actionable education and improvement plans.
• Track Home Health Quality Reporting Program indicators, value-based purchasing metrics, process measures, and patient outcome measures.
• Participate in QAPI, Clinical Documentation Improvement activities, root cause analyses, quality committees, and performance improvement initiatives.
• Support survey readiness, regulatory surveys, audits, interdisciplinary care conferences, and leadership discussions.
• Maintain audit findings, compliance reports, and quality performance dashboards, and ensure timely completion and state submission of required OASIS data.
• Cross-train on the Hospice Outcomes and Patient Evaluation (HOPE) assessment and provide hospice coverage as assigned.

Requirements

• Current New Hampshire license in good standing as a Registered Nurse (RN), Physical Therapist (PT), or Occupational Therapist (OT).
• Current COS-C (Certificate for OASIS Specialist-Clinical) certification.
• Current HCS-D (Home Care Clinical Specialist - Diagnosis Coding) certification.
• At least three years of home health experience.
• At least two years of experience reviewing OASIS assessments and home health clinical documentation.
• Demonstrated home health ICD-10-CM coding experience.
• Experience with clinical auditing, chart review, staff education, quality improvement, outcome measurement, and regulatory compliance.
• Extensive knowledge of CMS Home Health Conditions of Participation, OASIS guidance and scoring conventions, home health ICD-10-CM coding, quality measures, and value-based purchasing programs.
• Strong analytical, auditing, problem-solving, organizational, communication, education, coaching, and mentoring skills.
• Ability to interpret Medicare regulations and payer requirements, analyze performance data, and turn findings into practical improvement strategies.
• Proficiency with electronic medical records, OASIS software, and Microsoft Office applications.
• Current driver's license and reliable transportation if travel is required.

Preferred Qualifications

• Additional certification in home health quality, compliance, or education.