Home Health Coding and Quality Assurance Specialist
hace 10 días
Chicago
Job DescriptionHome Health Coding and Quality Assurance Specialist Company: Anuco Home Health Care, LLC Location: Office Position Employment Type: Full-Time Reports To: Administrator and Director of Nursing Position Summary Anuco Home Health Care, LLC is seeking a highly experienced and detail-oriented Home Health Coding and Quality Assurance Specialist to support the accuracy, compliance, and timely completion of our clinical documentation. The ideal candidate will have extensive experience in Medicare-certified home health, ICD-10-CM coding, OASIS review, Plan of Care development, clinical documentation compliance, and the Axxess Home Health platform. This individual must be able to identify documentation inconsistencies, communicate corrections clearly, and ensure that records support the patient’s diagnoses, skilled needs, homebound status, medical necessity, and ordered services. This is a critical position responsible for protecting clinical quality, regulatory compliance, accurate reimbursement, and timely billing. Primary Responsibilities Home Health Coding • Review clinical documentation and assign accurate, specific ICD-10-CM diagnosis codes., • Confirm that the primary diagnosis accurately reflects the principal reason for home health services., • Sequence primary and secondary diagnoses according to current ICD-10-CM and home health coding guidelines., • Verify that all diagnoses are supported by the referral documents, physician records, face-to-face documentation, hospital records, medication profile, and clinical assessment., • Identify diagnoses that require clarification or additional documentation before coding., • Review coding for wounds, diabetes, cardiovascular conditions, neurological disorders, orthopedic conditions, aftercare, injuries, infections, and other complex clinical conditions., • Monitor annual and quarterly coding updates and communicate applicable changes to the clinical team., • Ensure coding supports accurate reimbursement while maintaining full regulatory and ethical compliance., • Avoid unsupported, inaccurate, or inappropriate diagnosis coding.OASIS and Quality Assurance Review, • Perform comprehensive QA reviews of SOC, ROC, Recertification, Transfer, Discharge, and other applicable OASIS assessments., • Review OASIS documentation for accuracy, consistency, completeness, and alignment with the patient’s clinical condition., • Verify consistency among the OASIS assessment, diagnoses, medication profile, functional status, Plan of Care, visit notes, orders, and other clinical documentation., • Confirm that the documentation supports Medicare eligibility, homebound status, skilled need, medical necessity, and reasonable and necessary services., • Identify conflicting answers, unsupported responses, missing documentation, inaccurate functional scoring, and potential compliance risks., • Review hospitalization risk factors and other required clinical elements for accuracy., • Ensure assessments and corrections are completed within required regulatory and agency timeframes., • Provide clear, specific, and educational correction requests to clinicians., • Review corrected documentation to confirm that all QA concerns have been appropriately resolved.Plan of Care and Clinical Documentation Review, • Review Plans of Care and certifications for accuracy, completeness, and consistency with the physician’s orders and clinical assessment., • Confirm that disciplines, visit frequencies, goals, interventions, precautions, and treatment orders are individualized and clinically appropriate., • Ensure that therapy evaluations and reassessments support the ordered treatment plan., • Review skilled nursing, therapy, social work, and home health aide documentation for quality and compliance., • Confirm that visit notes demonstrate skilled services, patient response, progress toward goals, education provided, and communication with physicians., • Identify copied, repetitive, contradictory, incomplete, or non-patient-specific documentation., • Verify that medication discrepancies, changes in condition, wounds, missed visits, physician notifications, and care coordination activities are properly documented., • Review recertification records to ensure continued services are reasonable, necessary, and supported by the patient’s current condition and progress.Axxess Technology Responsibilities, • Demonstrate advanced proficiency in Axxess Home Health., • Navigate patient charts, OASIS assessments, Plans of Care, orders, visit notes, medication profiles, wound documentation, scheduling, QA functions, and billing-related clinical workflows., • Enter and update coding information accurately within Axxess., • Assign, track, return, and clear QA corrections using the appropriate Axxess workflow., • Monitor outstanding documentation and identify records that may delay billing, authorization, or claim submission., • Review Axxess alerts, dashboards, reports, and task queues to ensure timely completion., • Assist clinicians and office personnel with Axxess documentation questions and workflow concerns., • Help improve the agency’s use of Axxess tools, templates, reports, and quality-control processes., • Maintain confidentiality and comply with HIPAA requirements when accessing electronic patient records.Compliance Responsibilities, • Maintain working knowledge of current:, • Medicare Conditions of Participation, • CMS Home Health regulations, • OASIS guidance and conventions, • ICD-10-CM coding guidelines, • Medicare Benefit Policy Manual requirements, • Home health certification and recertification requirements, • Face-to-face encounter requirements, • Illinois home health regulations, • ACHC accreditation standards, • HIPAA and patient-privacy requirements, • Identify documentation trends that may expose the agency to denials, payment reductions, audits, recoupments, or compliance concerns., • Escalate significant clinical, coding, documentation, or compliance concerns to agency leadership., • Assist with internal audits, performance-improvement activities, survey preparation, denial prevention, and corrective-action plans., • Participate in staff education regarding coding, OASIS, documentation quality, and regulatory requirements.Required Qualifications, • Minimum of three years of recent coding or quality assurance experience within a Medicare-certified home health agency., • Demonstrated hands-on experience using Axxess Home Health., • Strong knowledge of ICD-10-CM coding, OASIS requirements, Medicare home health regulations, and clinical documentation standards., • Experience reviewing SOC, ROC, Recertification, Transfer, and Discharge assessments., • Ability to interpret hospital records, referral documents, physician notes, medication profiles, Plans of Care, and multidisciplinary clinical documentation., • Strong understanding of skilled need, homebound status, medical necessity, face-to-face requirements, and certification requirements., • Excellent written and verbal communication skills., • Exceptional attention to detail, organization, critical thinking, and time management., • Ability to manage a high-volume workload while meeting established QA turnaround times., • Ability to provide constructive feedback and work professionally with nurses, therapists, physicians, and office personnel., • Reliable access to a secure workspace and internet connection if working remotely.Preferred Qualifications, • Active clinical license, such as RN/LPN, • Current home health coding certification, including HCS-D, BCHH-C, or an equivalent credential., • Current OASIS certification, including COS-C, HCS-O, or an equivalent credential., • Five or more years of home health coding or QA experience., • Experience with Medicare Advantage and Medicaid home health documentation., • Experience with wound documentation, therapy documentation, utilization review, authorizations, denials, appeals, and survey readiness., • Previous experience training clinicians or developing documentation-improvement programs., • Experience reviewing records for billing readiness and claim compliance.Performance Expectations The Coding and QA Specialist will be expected to: • Complete assigned reviews within established agency timeframes., • Maintain a high level of coding and OASIS accuracy., • Reduce preventable documentation errors and billing delays., • Provide clear, actionable, and clinically appropriate correction requests., • Track outstanding corrections through final resolution., • Identify recurring documentation trends and recommend staff education., • Maintain professional communication with clinical and administrative personnel., • Protect patient information and comply with all agency confidentiality requirements., • Consistently support compliant, accurate, and patient-specific documentation.Ideal Candidate The ideal candidate does more than check boxes. This individual understands how the entire home health record must work together—from the referral and face-to-face encounter through the OASIS assessment, coding, Plan of Care, visit documentation, orders, recertification, discharge, and billing. The successful candidate will be comfortable holding clinicians accountable, explaining required corrections, identifying compliance risks, and helping the agency maintain high standards without compromising accuracy or patient care. Application Requirements Qualified applicants should submit: • A current résumé., • A summary of home health coding and QA experience., • A list of current coding, OASIS, and clinical credentials., • The number of years of hands-on Axxess experience., • A description of the Axxess functions used in previous positions., • Availability and desired employment arrangement., • Professional references with relevant home health experience.Selected candidates may be required to complete an Axxess proficiency assessment and a practical home health coding and OASIS review exercise. Equal Employment Opportunity Anuco Home Health Care, LLC is an equal opportunity employer. Employment decisions are based on qualifications, experience, performance, and organizational needs without discrimination based on any legally protected characteristic.
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