Pinnacle Home Care · 19 hours ago
QA Specialist - RN
United States
Full-time
Remote
Mid Level
3+ years expPinnacle Home Care is Florida’s largest independent Medicare-certified home health provider, delivering exceptional, patient-centered care for over two decades. They are seeking a Quality Assurance Specialist – Registered Nurse to perform coding, quality reviews, and ensure compliance with healthcare regulations.
Health CareHospitalNursing and Residential Care
Responsibilities
Perform centralized coding using scanned medical records and clinician documentation within the EMR
Provide comprehensive home health coding, OASIS, Plan of Care (POC), and quality reviews
Make independent determinations regarding accurate ICD-10-CM coding, OASIS data, POC accuracy, and quality assignments
Review medical records and recommend changes for clinician review and acceptance in accordance with CMS regulations, industry standards, and coding conventions, as supported by documentation
Review Plans of Care for accuracy and quality, and provide recommendations for improvement
Apply expert knowledge of medical terminology, disease processes, and pharmacology
Assess and review clinical assessments for coding accuracy, OASIS compliance, CMS regulations, coding conventions, and overall Plan of Care quality
Code all assessments using ICD-10-CM (SHP and Decision Health Coding Pro software) and appropriate industry references
Collaborate with the Team Lead and/or Director of Quality & Clinical Outcomes to resolve complex coding issues
Participate in ongoing education related to ICD-10 coding, OASIS, quality standards, and Plan of Care development; monitor regulatory changes and communicate updates to leadership
Meet or exceed auditing and productivity benchmarks, maintaining a minimum quality score of 93% on monthly and/or quarterly audits
Plan, prioritize, and organize work effectively to meet established objectives and deadlines
Ensure efficient and appropriate use of company resources, including equipment and services
Assist with special projects and perform additional duties as assigned
Adhere to all federal, state, and agency regulations, maintaining strict confidentiality of patient and agency information in compliance with HIPAA requirements
Follow the Code of Conduct and submit all documentation in a timely manner per agency policy
Attend required in-service training and educational programs
Qualification
Required
Current, active Registered Nurse (RN) license
Nationally accredited ICD-10 coding certification, maintained annually (e.g., HCS-D)
Nationally accredited OASIS certification, maintained annually (e.g., HCS-O or COS-C)
Formal clinical background
Minimum of three (3) years of ongoing ICD-10-CM coding and abstracting experience in a home health setting
Proficiency with PCs, web-based portals, database software, and Microsoft Office Suite (Access, Excel, Outlook, PowerPoint, and Word)
Preferred
Minimum of three (3) years of ongoing ICD-10-CM coding and abstracting experience in a home health setting
Home health experience
OASIS analysis experience
Working knowledge of SHP and/or Decision Health Coding Pro
Benefits
Complimentary Continuing Education Units (CEUs) to support licensure and career growth.
Includes an employee referral program with reward opportunities.
Company
Pinnacle Home Care
Pinnacle Home Care is a full service Medicare Certified and Home Health Company locally owned and operated by home health professionals.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Victoria Giuliani
Vice President Human Resources
Company data provided by crunchbase