Optimal Care

QA Engineer

• Apply accurate ICD-10-CM diagnosis codes based on patient conditions and disease processes in accordance with current coding guidelines
• Review and validate Face-to-Face documentation for Home Health and Hospice to ensure regulatory compliance
• Identify the appropriate focus of care for Home Health and confirm eligibility criteria for Hospice patients
• Audit medical records using critical thinking skills to ensure documentation accuracy and compliance
• Communicate significant findings, compliance concerns, or documentation discrepancies to the Director of Quality Assurance and QA Specialists
• Assist in tracking documentation and coding to support timely billing and regulatory adherence
• Prepare reports as directed by the Director of Quality Assurance
• Monitor and stay current on Conditions of Participation (CoPs) and regulatory changes impacting quality improvement and patient care
• Ensure compliance with federal, state, local, Medicare, Medicaid, third-party payer, and OSHA regulations
• Identify and report potential coverage or reimbursement concerns
• Manage workflow, recognize sequencing issues, and recommend solutions to prevent disruption to patient care
• Assist with special audits and quality initiatives as assigned

Quality Assurance Coder