Documentation Integrity Nurse, RN

Abby Care • Worcester, MA

1d

About The Position

Making family care possible. At Abby Care, we are tackling one of the most important and unsolved challenges of our time: family caregiving.

Over 50 million Americans are family caregivers for loved ones without pay, tools, or support. Our mission is clear and ambitious: to train and employ family caregivers so they can get paid for the care they already provide at home.

Abby Care is building a tech-powered, family-first care platform to efficiently deliver care, improve health outcomes, and provide the best-in-class experience nationwide.

We are rapidly expanding our mission and looking for passionate team members to join. Abby Care has partnered with leading insurance plans, healthcare providers, and community organizations. We’re supported by top, mission-driven VCs to empower families throughout the country.
Position Summary:
The Clinical Documentation Integrity Nurse is responsible for ensuring regulatory, payer, and internal compliance related to home health documentation and revenue cycle processes. This role conducts systematic audits of face-to-face documentation, plans of care, physician orders, authorizations, medical necessity, and billing documentation to ensure adherence to Medicaid and commercial payer requirements.

Requirements

• Active RN license in good standing
• Minimum 2 years home health experience
• Strong knowledge of:
• Medicare COPs
• Face-to-face requirements
• Prior authorization processes
• Detail oriented with strong analytical skills
• Ability to work independently and manage audit timelines

Responsibilities

• Conduct comprehensive pre-onboarding audits of all patient and caregiver documentation to review for adherence to established regulatory standards and escalate discrepancies. prior to activation of services.
• Verify the presence of physician orders, plans of care, prior authorizations, skills assessments, supervision requirements, and all supporting clinical documentation are compliant with MassHealth and ACHC standards.
• Audit prior authorizations for accuracy and alignment with delivered services.
• Ensure that both patient and caregiver records are complete, accurate, and audit-ready before services begin.
• Confirm services billed match authorized hours, documented visits, and approved disciplines.
• Identify documentation gaps and share with appropriate Manager for resolution as needed
• Collaborates with Intake, Nursing, Operations, and Compliance teams to share audit results to reinforce compliant workflows.
• Support DON with conducting routine and targeted audits for the purposes of meeting QAPI expectations and measuring the success of Process Improvement Initiatives
• Participates in quarterly sampling audits (typically 10%) of identified quality indicators, including intake accuracy, documentation compliance, regulatory support documentation, Human Resource files, and other quality indicators as needed
• Documents audit findings, trends, and compliance risks; escalates issues to DON/Administrator, General Manager, ,MA Management Team, and Compliance Manager.
• Provides feedback and education to clinicians regarding documentation gaps in conjunction with QA team.
• Monitor Slack channels for clinical team questions regarding clinical processes and documentation practices
• Review of Intake documentation to determine if the patient pre qualifies for our services.
• Reviews Face-to-Face encounter documentation to confirm regulatory compliance and clinical support for services, particularly HHA services.
• Coverage for SOCs and Re-Cert visits as needed
• Coverage for HHA Skills Assessments and Training Labs as needed

What This Job Offers

• Education Level: No Education Listed