Home Health Quality Assuranc / Coding Specialist

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.

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.