Optimal Care ยท 18 hours ago
Quality Assurance Coder
Jackson, MI
Full-time
Hybrid
Mid Level
3+ years expOptimal Care is a clinician owned and operated company that focuses on providing exceptional quality care through an integrated care delivery model. The Quality Assurance Coder will ensure accurate coding for home care and hospice cases, supporting regulatory compliance and high-quality patient care while working closely with the quality assurance team.
Health CareHealth DiagnosticsMedical
Responsibilities
Apply ICD-10 diagnosis codes to patient conditions and disease processes using current coding guidelines
Identify and code the primary focus of care and terminal diagnoses along with all relevant comorbidities
Ensure accurate coding to support PDGM reimbursement and regulatory compliance
Maintain expertise in ICD-10-CM coding standards and stay current with updates
Review Face-to-Face documents for home health and hospice regulatory compliance
Use Face-to-Face documentation to identify focus of care for home health patients
Verify continuing criteria for eligibility for hospice patients
Audit medical records using critical thinking skills to ensure accuracy and completeness
Communicate significant findings, problems, and changes related to compliance standards to leadership
Monitor federal, state, and local regulations including CMS Conditions of Participation
Stay informed about Medicare, Medicaid, and third-party payor requirements
Identify and report potential payment coverage issues proactively
Track cases to ensure timely billing and regulatory compliance
Identify problematic coding sequences and provide solutions to prevent care disruptions
Prepare reports as directed by the Director of Quality Assurance
Participate in special audits as requested or assigned
Maintain knowledge of changes in Conditions of Participation affecting quality improvement
Ensure adherence to all federal, state, local, and OSHA regulations
Support compliance initiatives across the organization
Contribute to continuous quality improvement activities
Qualification
Required
High school diploma
ICD-10 coding certification
Minimum 3 years of quality assurance experience
Current knowledge of ICD-10-CM coding guidelines
Reliable transportation with valid automobile insurance
Expert knowledge of ICD-10 coding standards and regulations
Strong understanding of home health care and hospice reimbursement (PDGM)
Demonstrated decision-making and analytical skills
Critical thinking abilities with attention to detail
Effective verbal and written communication skills
Strong interpersonal skills for collaboration with clinical and administrative teams
Ability to interpret and apply complex regulatory requirements
Preferred
Microsoft Office proficiency preferred
Benefits
Minimum of 3 Weeks Paid Time Off (PTO)
Company Vehicle Program
Flexible Work Schedule
Mentorship Culture
Medical, Dental, and Vision Insurance
401(k) with Employer Match
Mileage Reimbursement
Cutting Edge Technology
Company
Optimal Care
Optimal Care is the Midwest's premier provider of Physician Services, Home Health, and Hospice Care.
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase