Home Health Quality Assurance

We are looking for a detail-oriented Quality Control for Coding Specialist to ensure the accuracy, compliance, and consistency of medical coding and billing practices. This role plays a vital part in maintaining the integrity of health data and optimizing the revenue cycle by implementing internal audits, reviews, feedback processes, and continuous improvement initiatives. You'll be part of a team committed to Leadership, Excellence, Innovation, and a culture of Agility, Accountability, Collaboration, and Customer Centricity.

Key Responsibilities

Delighting Our Customers & Stakeholders

• Ensure coding accuracy using ICD-10, CPT, and applicable guidelines
• Perform internal audits and peer reviews
• Validate clinical documentation supports coded entries
• Enforce compliance with HIPAA and payer requirements

Growing Our Business

• Reduce coding-related denials and rejections
• Support revenue cycle optimization through timely audits
• Recommend process enhancements and tools for better accuracy
• Contribute insights to client engagement and support activities

Improving the Way We Work

• Use audit tools and QC platforms to automate checks
• Maintain and update audit protocols and workflows
• Analyze data trends to address recurring issues
• Collaborate across departments for process alignment

Developing Myself and Others

• Provide feedback and coaching to coding team members
• Lead or join training sessions on compliance and coding standards
• Stay updated on industry guidelines and certifications
• Promote a quality-first, learning-driven culture

Key Metrics

• ≥ 95% coding accuracy rate
• ≥ 90% clean claims rate
• ≤ 5% documentation-related coding error rate
• ≥ 20% YOY reduction in coding-related denials
• ≥ 90% adherence to QC protocols and audit schedules
• ≥ 2 professional development activities per year

Qualifications

• Degree in Health Information Management, Nursing, or related field
• Certified Professional Coder (CPC), CCS, or equivalent
• 2–3 years experience in medical coding and quality control
• Knowledge of ICD-10, CPT, HCPCS, CMS, and payer-specific guidelines
• Proficiency in medical coding software and audit platforms
• Strong analytical, communication, and collaboration skills