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.