Quality Assurance Specialist

The Quality Assurance Nurse is responsible for ensuring clinical documentation accuracy, regulatory compliance, and revenue protection for the agency’s Medicare home health operations. This role reviews OASIS assessments, Plans of Care, visit documentation, and billing readiness to ensure full compliance with Medicare Conditions of Participation and agency standards.

This position plays a critical role in survey readiness, ADR defense, and maintaining strong quality metrics including HHVBP and star ratings.

• Clinical Chart Review
  • Review Start of Care, Recertification, Resumption of Care, and Discharge OASIS assessments for accuracy and consistency.
  • Audit skilled nursing, PT, OT, SLP, and MSW documentation for medical necessity and defensibility.
  • Ensure Plan of Care aligns with diagnoses, interventions, and measurable goals.
  • Verify documentation supports homebound status and skilled need.
• OASIS & Coding Oversight
  • Validate OASIS accuracy prior to submission.
  • Ensure alignment between OASIS, physician orders, and documentation.
  • Collaborate with coding staff to confirm correct ICD-10 coding.
  • Monitor PDGM case mix accuracy and reimbursement optimization.
  • Ensure compliance with CMS Conditions of Participation.
  • Monitor adherence to agency policies and procedures.
  • Identify trends that could create survey deficiencies.
  • Lead corrective action plans when needed.
• Revenue Protection
  • Review charts for billing readiness.
  • Prevent denials through proactive QA review.
  • Assist with ADR, TPE, or audit responses.
• Quality Improvement
  • Track quality metrics including hospitalization rates, HHCAHPS, and functional outcomes.
  • Provide feedback and education to clinicians.
  • Participate in QAPI meetings.
• Staff Education
  • Train clinicians on documentation standards.
  • Provide real-time feedback to field staff.
  • Support onboarding of new clinicians.
  • Develop documentation guides and checklists.

• Active RN license in Virginia
• Minimum 3 years of Medicare home health experience
• Strong OASIS knowledge
• Deep understanding of PDGM reimbursement
• Experience with survey readiness and Conditions of Participation
• Familiarity with EMR systems such as Homecare Homebase
• Strong analytical and documentation review skills

• OASIS certification
• Coding certification (HCS-D or equivalent)
• Experience responding to ADRs or audits

• Detail obsessed
• Comfortable pushing back on clinicians
• Not afraid to correct documentation
• Think in risk management terms
• If they are conflict-avoidant, they are the wrong hire.