Home Health QA Specialist

Nestmed is an AI healthcare technology company focused on improving clinical documentation for home healthcare. The Home Health QA Specialist reviews coding, OASIS assessments, and clinical documentation for accuracy and compliance, while identifying risks, escalating incomplete records, and providing feedback to improve AI-supported workflows.

Responsibilities

Own your queue. Complete 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

Validate the coding. Check 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

Hold OASIS to the record. Confirm 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. No copy-forward answers

Know where the risk lives. Give 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

Flag what's missing, clearly. When documentation is incomplete, unsigned, unclear, or contradictory, put the chart on hold or escalate it — and write the QA comment specific enough that a coder, clinician, or client can act on it without calling you to ask what you meant

Push back on the AI, then feed it forward. Review AI-generated coding, OASIS, and documentation suggestions with your own clinical judgment instead of deferring to them. When you spot a pattern — recurring errors, missed cues, a gap in the workflow — report it through the approved channel; your corrections are training data

Keep the record airtight. Maintain HIPAA compliance and confidentiality across patient, client, and AI workflow data, and stay on top of the tracking, hold notes, and certification paperwork the role requires — including telling management immediately if a certification lapses

Keep improving. Maintain your quality score, take secondary review and audit feedback without defensiveness, and show up for the training and calibration sessions that keep the team's interpretation consistent

Benefits

Remote work (U.S.)

Company

AI platform for home health and hospice

San Francisco, California, USA

https://www.nestmed.com/

Founded in 2023

11-50 employees

Qualifications

• 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 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

OASIS HCS-O, COS-C, or another company-approved OASIS certification. May be required at hire or obtained within a management-approved timeframe

Coding Current applicable coding credential, per company standards and client scope

Required skills

Home health chart review, OASIS, ICD-10-CM coding, Clinical documentation review, HIPAA compliance, AI-assisted workflow, Clinical judgment

Experience

Mid level