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Pinnacle Home Care · 2 days ago

QA Specialist - RN

United States

Full-time

Remote

Mid Level

3+ years exp

Pinnacle Home Care is Florida’s largest Medicare-certified home health provider, dedicated to delivering compassionate healthcare at home. They are seeking a Quality Assurance Specialist Registered Nurse to perform centralized coding, review medical records, and ensure compliance with CMS regulations and quality standards.

Health CareHospitalNursing and Residential Care

Growth Opportunities

Responsibilities

Perform centralized coding via scanned medical records and clinician documentation via EMR data

Provide home health coding, OASIS, POC, and quality review

Make independent decisions regarding accurate ICD-10-CM coding and OASIS, POC, and quality data assignments

Review records and recommend changes for clinician review and acceptance based on CMS regulation, industry standards, and coding convention as supported by documentation

Review Plan of Care for accuracy and quality and make needed recommendations

Apply knowledge of medical terminology, disease processes, and pharmacology

Assess and review assessments for coding accuracy based on documentation, CMS regulations and coding conventions, OASIS compliance, and Plan of Care quality and accuracy

Maintain minimal productivity number standards daily

Code all assessments using ICD-10-CM (SHP, and Decision Health Coding Pro software) as well as appropriate industry references

Consult Team Lead and/or Director of Quality & Clinical Outcomes and work out difficult codes and coding problems as needed

Participate in continuous learning and education in ICD-10 coding, OASIS, Quality and Plan of Care development as necessary. Monitor regulatory changes and communicate these changes to the Director of Quality & Clinical Outcomes

Meet or exceed minimum auditing and productivity scores for coding quality and compliance. Maintain quality of coding review with a score of 93% or greater on monthly and/or quarterly quality audits

Plan, prioritize, organize, and complete work to meet established objectives

Ensure the efficient and appropriate use of all company financial resources, including but not limited to arrangements for equipment and other necessary items and services needed

Assist with a variety of special projects and other duties as needed

Adhere to federal, state, and agency regulations and policies to maintain confidentiality of patients and agency information per HIPPA requirements

Follow the Code of Conduct policy and submit all documentation in a timely manner according to agency policy

Attend in-service and education as required

Qualification

RN licenseICD-10 certificationOASIS certificationCoding experienceMicrosoft Office SuiteHome health experienceSHP knowledgeDecision Health Coding ProClinical background

Required

Current RN license

Must currently hold a nationally accredited Coding ICD-10 certification required and maintained yearly, e.g., HCS-D

Must currently hold a nationally accredited OASIS certification, required and maintained yearly, e.g., HCS-O or COS-C

Formal clinical background

Must be proficient in the use of a PC, web-based portals, database software, and Microsoft Office Suite (Access, Excel, Outlook, Power Point and Word)