QA Specialist - RN

Pinnacle Career • Oldsmar, FL

1d

About The Position

Are you looking to make a difference in patients’ lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most –– at home. Pinnacle Home Care, Florida’s largest Medicare-certified home health provider, has been delivering high-quality, patient-centered care for over two decades, and we’re looking for a Quality Assurance Specialist Registered Nurse to join our award-winning team.

Requirements

• Current RN license.
• Must currently hold a nationally accredited Coding ICD-10 certification required and maintained yearly, e.g., HCS-D.
• Must currently hold a nationally accredited OASIS certification, required and maintained yearly, e.g., HCS-O or COS-C.
• Formal clinical background.
• Minimum three years of ongoing coding and abstracting experience in ICD-10-CM for home health agencies preferred.
• Must be proficient in the use of a PC, web-based portals, database software, and Microsoft Office Suite (Access, Excel, Outlook, Power Point and Word).

Nice To Haves

• Home health experience preferred.
• Experience with OASIS analysis preferred.
• Knowledge of SHP and/or Decision Health Coding Pro preferred.

Responsibilities

• Perform centralized coding via scanned medical records and clinician documentation via EMR data.
• Provide home health coding, OASIS, POC, and quality review.
• Make independent decisions regarding accurate ICD-10-CM coding and OASIS, POC, and quality data assignments.
• Review records and recommend changes for clinician review and acceptance based on CMS regulation, industry standards, and coding convention as supported by documentation.
• Review Plan of Care for accuracy and quality and make needed recommendations.
• Apply knowledge of medical terminology, disease processes, and pharmacology.
• Assess and review assessments for coding accuracy based on documentation, CMS regulations and coding conventions, OASIS compliance, and Plan of Care quality and accuracy.
• Maintain minimal productivity number standards daily.
• Code all assessments using ICD-10-CM (SHP, and Decision Health Coding Pro software) as well as appropriate industry references.
• Consult Team Lead and/or Director of Quality & Clinical Outcomes and work out difficult codes and coding problems as needed.
• Participate in continuous learning and education in ICD-10 coding, OASIS, Quality and Plan of Care development as necessary.
• Monitor regulatory changes and communicate these changes to the Director of Quality & Clinical Outcomes.
• Meet or exceed minimum auditing and productivity scores for coding quality and compliance.
• Maintain quality of coding review with a score of 93% or greater on monthly and/or quarterly quality audits.
• Plan, prioritize, organize, and complete work to meet established objectives.
• Ensure the efficient and appropriate use of all company financial resources, including but not limited to arrangements for equipment and other necessary items and services needed.
• Assist with a variety of special projects and other duties as needed.
• Adhere to federal, state, and agency regulations and policies to maintain confidentiality of patients and agency information per HIPPA requirements.
• Follow the Code of Conduct policy and submit all documentation in a timely manner according to agency policy.
• Attend in-service and education as required.

Benefits

• Growth & Stability: Over two decades as Florida’s largest home health agency.
• Ongoing Professional Development: Free Continuing Education Units (CEUs) to support licensure and career advancement.
• Competitive Benefits & Perks: Including an employee referral program where you can earn rewards.
• Recognized Excellence: Ranked as a USA Today Top Workplace.
• Supportive & Fun Culture: Join a collaborative, forward-thinking team that values both professional excellence and personal fulfillment.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed