This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

The Home Health Quality Assurance Registered Nurse (QA RN) is responsible for coding, reviewing, validating, and correcting OASIS assessments to ensure clinical accuracy, regulatory compliance, and optimal reimbursement. This role supports agency performance by improving documentation quality, reducing payment risk, and ensuring adherence to CMS, Medicare, and payer guidelines. This is an adaptive, remote-friendly role designed to scale with agency census and workflow needs.

Key Responsibilities

• OASIS Quality Review & Coding
  • Review all assigned OASIS assessments (SOC, ROC, Recert, Transfer, Discharge) for:
    • Accuracy, completeness, and internal consistency
    • Proper clinical coding and scoring
    • Alignment with visit documentation and orders
  • Validate diagnosis coding and sequencing per CMS guidelines
  • Identify and correct errors impacting reimbursement, quality measures, or compliance
  • Provide clear, actionable feedback to clinicians when revisions are required
• Compliance & Regulatory Oversight
  • Ensure OASIS submissions meet current CMS, Medicare, and payer requirements
  • Maintain awareness of OASIS updates, CMS guidance, and regulatory changes
  • Support agency compliance with Conditions of Participation (CoPs)
• Quality Improvement Support
  • Identify recurring documentation trends or risk areas
  • Contribute recommendations for clinician education and process improvement
  • Collaborate with clinical leadership to improve outcomes and reduce audit risk
• Productivity & Timeliness
  • Complete assigned OASIS reviews within defined turnaround times
  • Maintain high accuracy standards while meeting productivity expectations
  • Communicate promptly regarding discrepancies or missing documentation

Qualifications

• Active, unrestricted Registered Nurse (RN) license
• Minimum 2 years of home health experience
• ICD10 Coding Certification (HCS-D, or equivalent)
• OASIS Certification (COS-C, or equivalent)
• Strong understanding of Medicare home health reimbursement and PDGM
• High attention to detail and strong clinical judgment
• Ability to work independently in a remote or hybrid environment

Requirements

• Prior experience in home health QA, auditing, or coding (preferred)
• Familiarity with common home health EMRs (HCHB, AXXESS, etc.) (preferred)
• Experience working in a per-review or productivity-based role (preferred)

Performance Expectations

• Accurate and compliant OASIS reviews with minimal rework
• Consistent turnaround times
• Clear, professional communication with clinicians and leadership
• Ongoing adherence to quality and compliance standards

Physical & Technical Requirements

• Ability to work at a computer for extended periods
• Reliable internet access and secure workspace
• Proficiency with EMR systems and Microsoft Office