Quality Assurance Coder

Job Description

Optimal Care is where your dedication meets a rewarding career.

As a clinician owned and operated company, we create the opportunity and environment for each employee to realize their highest potential while maintaining a personalized focus on our Patients and Families every day. We are the Midwest's premier provider of Physician Services, Home Health, and Hospice Care. Our integrated care delivery model incorporates technology, innovation and best practices. We produce value based outcomes by managing chronic disease process, rehabilitation and end of life care.

We live a simple Mission:
Serve Together, Provide Value, and Deliver Exceptional Quality Care.

What does this mean for you? At Optimal Care, you have our resolute commitment to being an exceptional place to work. Your expertise, passion and commitment to exceptional quality care will continue to thrive. With you we can build a remarkable place to work.

Exceptional 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

The Quality Assurance Coder is responsible for accurately coding Home Health and Hospice cases in accordance with current ICD-10-CM coding guidelines and regulatory standards. This role ensures the primary focus of care or terminal diagnosis, along with all relevant comorbidities, are captured accurately to support high-quality patient care, regulatory compliance, and appropriate reimbursement under PDGM.

This position plays a critical role in maintaining documentation integrity, supporting timely billing, and ensuring compliance with federal, state, and payer requirements.

In This Role, You Will:

• Apply accurate ICD-10-CM diagnosis codes based on patient conditions and disease processes in accordance with current coding guidelines
• Review and validate Face-to-Face documentation for Home Health and Hospice to ensure regulatory compliance
• Identify the appropriate focus of care for Home Health and confirm eligibility criteria for Hospice patients
• Audit medical records using critical thinking skills to ensure documentation accuracy and compliance
• Communicate significant findings, compliance concerns, or documentation discrepancies to the Director of Quality Assurance and QA Specialists
• Assist in tracking documentation and coding to support timely billing and regulatory adherence
• Prepare reports as directed by the Director of Quality Assurance
• Monitor and stay current on Conditions of Participation (CoPs) and regulatory changes impacting quality improvement and patient care
• Ensure compliance with federal, state, local, Medicare, Medicaid, third-party payer, and OSHA regulations
• Identify and report potential coverage or reimbursement concerns
• Manage workflow, recognize sequencing issues, and recommend solutions to prevent disruption to patient care
• Assist with special audits and quality initiatives as assigned

Required Qualifications

• High School Diploma or GED
• Current ICD-10 Coding Certification
• Minimum 3 years of quality assurance experience
• Demonstrated interpersonal skills with ability to communicate effectively
• Demonstrated decision making and financial management skills
• Exhibits working knowledge of regulations and reimbursement in home health and hospice
• Willing to develop new critical thinking skills

Desired Qualifications

• Microsoft office skills preferred

Location

• This is a remote opportunity for individuals living in Michigan, Ohio, Indiana, Mississippi, or Texas only

Hours

• 8:00 am – 5:00 pm, Monday through Friday

Pay Range $21—$30 USD

Background Screening Optimal Care conducts a background screening upon acceptance of a contingent job offer. Background screening is completed by a third-party administrator, the Michigan Long-Term Care Partnership, and is performed in compliance with the Fair Credit Report Act.

Reasonable Accommodations We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

Equal Opportunity Employer Optimal Care is an equal-opportunity employer.