Home Health QA Specialist

Nestmed

11d•$22 - $25•Remote

About The Position

Healthcare documentation is broken. Nestmed is fixing it with an AI platform that gives clinicians their time back. In just one year, we’ve scaled to support tens of thousands of clinicians across more than a million patient visits. We're now the trusted partner for over 60 home health agencies, including 7 of the top 10 enterprises in the US. Our founding team—hailing from Stanford, YC, Google, and Meta—is backed by the founders of PayPal and Plaid to build the essential infrastructure for the future of the $500B home healthcare industry.

Requirements

Real home health chart review experience — you know what a comprehensive assessment, a physician's note, and a therapy record are supposed to say, and you notice when they don't agree
Active or in-progress OASIS certification — HCS-O, COS-C, or another Nestmed-approved credential (in-progress is fine if you're working toward it on a defined timeline)
A current, applicable ICD-10-CM coding credential, HCS-D, BCHH-C, CPC, RHIT
Comfort working inside an AI-assisted workflow: critical enough to catch what the model misses, not so skeptical you ignore what it gets right
Writing skills tight enough that a QA comment doesn't need a follow-up conversation
The discipline to escalate instead of guess when a chart doesn't clearly support an answer

Responsibilities

Completing assigned Home Health QA reviews accurately, timely, and in alignment with company standards, client expectations, ICD-10-CM coding guidelines, OASIS guidance, payer requirements, AI supported workflow expectations, and internal quality protocols.
Demonstrating strong clinical documentation review skills, maintaining applicable certifications, supporting accurate OASIS outcomes, and working effectively in an AI enabled review environment.
Owning your queue and completing assigned Home Health reviews against your quota, prioritizing AI routing queues, holds, and anything management flags as urgent — within turnaround time, with delays or access issues flagged the moment you spot them.
Validating the coding by checking ICD-10-CM accuracy, sequencing, specificity, and guideline compliance: primary and secondary diagnoses, symptom and manifestation codes, etiology/manifestation pairing, laterality, encounter type, and whether the documentation actually backs up what's been coded.
Holding OASIS to the record by confirming every OASIS response is clinically supported, internally consistent, and matches CMS guidance — cross-referencing the comprehensive assessment, referral, physician documentation, therapy notes, wound care, medications, and hospital records.
Identifying risk by giving the closest attention to the items that move outcomes: GG items and functional status, M1800 ADLs, cognition, pain, dyspnea, falls, wounds, medication management, hospitalization risk, and discharge disposition.
Flagging missing documentation clearly when it is incomplete, unsigned, unclear, or contradictory, putting the chart on hold or escalating it — and writing the QA comment specific enough that a coder, clinician, or client can act on it without calling you to ask what you meant.
Pushing back on the AI, then feeding it forward by reviewing AI-generated coding, OASIS, and documentation suggestions with your own clinical judgment instead of deferring to them. Reporting patterns like recurring errors, missed cues, or a gap in the workflow through the approved channel.
Maintaining HIPAA compliance and confidentiality across patient, client, and AI workflow data, and staying on top of the tracking, hold notes, and certification paperwork the role requires — including telling management immediately if a certification lapses.
Maintaining your quality score, taking secondary review and audit feedback without defensiveness, and showing up for the training and calibration sessions that keep the team's interpretation consistent.