QA Specialist – RN, FL

QASPE010332 Description 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.

Key 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.

Qualifications

• Current RN license (state-specific).
• Associates degree or greater in a clinical program.
• Nationally accredited Coding ICD-10 certification required and maintained yearly.
• Nationally accredited OASIS certification required and maintained yearly.
• Formal clinical background.
• Minimum three years of on-going 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).
• Home health experience preferred.
• Experience with OASIS analysis preferred.
• Knowledge of SHP and/or Decision Health Coding Pro preferred.

Why Choose Pinnacle?

• 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.

Pinnacle promotes an inclusive environment and is an equal opportunity employer. We prohibit discrimination or harassment based on race, religion, age, gender, national origin, disability, veteran status, or other legally protected characteristics. Be part of a company that empowers clinicians to make a difference in the lives of over 10,000 patients across Florida every day. Apply now! Apply tot his job Apply To this Job