Home Health Quality Assuranc / Coding Specialist
$52,000–$52,000 year
On-siteSanta Ana, California, United States
Job Summary
Review patient records for completeness, accuracy, and regulatory compliance before billing. Conduct pre-bill and post-bill chart audits to ensure documentation supports skilled services and verify ICD-10-CM diagnosis codes for appropriate reimbursement. Validate OASIS assessments including Start of Care, Resumption of Care, Recertification, and Discharge to ensure accuracy and CMS timeliness. Communicate documentation deficiencies to clinical staff and provide education on coding updates and regulatory changes. Monitor quality indicators, maintain audit logs, and assist with agency QAPI initiatives and survey preparations. Collaborate with clinicians to clarify diagnoses and ensure documentation supports medical necessity and homebound status.
Required Qualifications
- Minimum of two (2) years of home health experience
- 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 of Medicare reimbursement methodologies (PDGM)
- Proficiency in OASIS-E documentation and CMS regulations
- 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
- Ability to lift up to 20 pounds occasionally
Desired 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 one (1) year of ICD-10 coding and OASIS review experience preferred
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