Home Health Quality Auditor

Humana • Miramar, OH

12d • Hybrid

About The Position

Become a part of our caring community and help us put health first The Home Health Quality Auditor ensures clinical documentation meets CMS regulations, OASIS accuracy, and Medicare Conditions of Participation. This role audits Start of Care, Recertification, and Discharge records for compliance, accuracy, and completeness, helping reduce audit risk and billing delays. The auditor monitors QA metrics, identifies trends, and collaborates with leadership to improve workflows, support Kinnser EMR transition, and drive continuous quality improvement. Use your skills to make an impact

Requirements

• Active RN license required; BSN or bachelor’s in health-related field preferred.
• Minimum 4 years of healthcare quality experience, with strong knowledge of CMS Home Health regulations and Medicare Conditions of Participation.
• Familiarity with OASIS requirements and home health documentation standards.
• Experience with EMR systems (Kinnser preferred).
• Proficient in Microsoft Office (Word, Excel) and data analysis tools.
• Strong communication skills with proven ability to provide education and present findings to leadership.
• Ability to work independently and manage multiple priorities effectively.

Responsibilities

• Audit Start of Care (SOC), Recertification, and Discharge documentation for completeness, accuracy, and compliance with CMS and payer requirements.
• Verify coding accuracy, medication reconciliation, and alignment of the plan of care with clinical documentation.
• Perform timely QA reviews to minimize billing delays and improve operational KPIs.
• Monitor QA dashboard metrics and provide actionable feedback to clinicians and leadership.
• Identify documentation trends and collaborate with leadership to develop targeted training and job aids.
• Ensure documentation workflows align with Kinnser EMR protocols during system transition.
• Conduct root cause analyses on recurring documentation errors and recommend corrective actions.
• Maintain audit tools, policies, and procedures to ensure consistency and inter-rater reliability.
• Present audit findings and performance trends to senior leadership and quality committees.
• Support continuous quality improvement initiatives to enhance compliance and patient safety.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees