Home Health QA Specialist

About the role

The QA Specialist will complete assigned Home Health QA 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.

Responsibilities

• 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. Give the closest attention to the items that move outcomes: GG items and functional status, M1800 ADLs, cognition, pain, dyspnea, falls, wounds, medication management, hospitalization risk, and discharge disposition. Flag what's missing, clearly.
• Push back on the AI, then feed it forward. Review AI-generated coding, OASIS, and documentation suggestions with your own clinical judgment instead of deferring to them. When you spot a pattern — recurring errors, missed cues, a gap in the workflow — report it through the approved channel; your corrections are training data.
• Maintain HIPAA compliance and confidentiality across patient, client, and AI workflow data, and stay on top of the tracking, hold notes, and certification paperwork the role requires — including telling management immediately if a certification lapses.
• Keep improving. Maintain your quality score, take secondary review and audit feedback without defensiveness, and show up for the training and calibration sessions that keep the team's interpretation consistent.

Requirements

• 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 escalate instead of guess when a chart doesn't clearly support an answer.

Qualifications

• OASIS HCS-O, COS-C, or another company-approved OASIS certification. May be required at hire or obtained within a management-approved timeframe.
• Coding: Current applicable coding credential, per company standards and client scope.

Skills

• Attention to detail
• Strong clinical documentation review skills
• Applicable certifications (OASIS, ICD-10-CM)
• Ability to work in an AI-enabled review environment
• Confidentiality and HIPAA compliance
• Effective communication and escalation skills

Benefits

• Professional development opportunities
• Competitive compensation package
• Flexible work schedule
• Health and wellness programs

Pay

Competitive salary based on experience and qualifications.

Schedule

Full-time position with flexible hours to accommodate patient needs.