Home Health QA Specialist

Location: Remote (U.S.)

The Role: You will be responsible for completing 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. The QA Specialist is expected to demonstrate strong clinical documentation review skills, maintain applicable certifications, support accurate OASIS outcomes, and work effectively in an AI enabled review environment.

What You'll Do: 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. When documentation is incomplete, unsigned, unclear, or contradictory, put the chart on hold or escalate it — and write the QA comment specific enough that a coder, clinician, or client can act on it without calling you to ask what you meant. 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. Keep the record airtight. 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. What You'll Bring 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 Certification Expectations 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.

Interview Process: Knowledge check quiz/assignment