Optima Health Puerto Rico
Overview
Optima Health Home Care Services is a leading integrated home health and specialty care organization in Puerto Rico, dedicated to improving patient outcomes through quality, compliance, and compassionate clinical care. Our multidisciplinary team supports patients across infusion therapy, wound care, and rehabilitation, ensuring excellence at every step. Position Summary
We are seeking a Home Health QA & Coding Specialist to oversee the quality, accuracy, and compliance of clinical documentation, OASIS assessments, and coding for reimbursement. This position ensures that all episodes meet CMS, Medicare Advantage, and ACHC standards, supporting accurate billing and outstanding patient outcomes. Key Responsibilities
Review and audit OASIS assessments and clinical documentation for accuracy, completeness, and compliance. Assign correct ICD-10 and HIPPS codes to ensure proper reimbursement. Conduct ongoing QA audits of patient charts, care plans, and clinical notes. Identify documentation gaps and provide feedback or education to field clinicians. Monitor adherence to Optima’s quality and compliance standards (CMS, JCAHO, HIPAA). Collaborate with the billing and operations teams to resolve discrepancies. Participate in staff training, internal audits, and performance improvement initiatives. Qualifications
Registered Nurse (RN) or other licensed clinical professional (e.g., PT, OT, or LPN) preferred. Minimum 2 years of experience in home health quality assurance, OASIS auditing, or clinical coding. Strong understanding of Medicare Conditions of Participation, CMS guidelines, and ACHC/Joint Commission standards. Proficiency in ICD-10 and home health coding methodologies (HHRG/HIPPS). Excellent communication, analytical, and organizational skills. Bilingual (English/Spanish) preferred. Why Join Optima
Competitive salary based on experience Supportive and collaborative work environment Opportunities for professional growth and continuing education Commitment to innovation and excellence in patient care Seniority level
Entry level Employment type
Full-time Job function
Health Care Provider Industries
Hospitals and Health Care
#J-18808-Ljbffr
Optima Health Home Care Services is a leading integrated home health and specialty care organization in Puerto Rico, dedicated to improving patient outcomes through quality, compliance, and compassionate clinical care. Our multidisciplinary team supports patients across infusion therapy, wound care, and rehabilitation, ensuring excellence at every step. Position Summary
We are seeking a Home Health QA & Coding Specialist to oversee the quality, accuracy, and compliance of clinical documentation, OASIS assessments, and coding for reimbursement. This position ensures that all episodes meet CMS, Medicare Advantage, and ACHC standards, supporting accurate billing and outstanding patient outcomes. Key Responsibilities
Review and audit OASIS assessments and clinical documentation for accuracy, completeness, and compliance. Assign correct ICD-10 and HIPPS codes to ensure proper reimbursement. Conduct ongoing QA audits of patient charts, care plans, and clinical notes. Identify documentation gaps and provide feedback or education to field clinicians. Monitor adherence to Optima’s quality and compliance standards (CMS, JCAHO, HIPAA). Collaborate with the billing and operations teams to resolve discrepancies. Participate in staff training, internal audits, and performance improvement initiatives. Qualifications
Registered Nurse (RN) or other licensed clinical professional (e.g., PT, OT, or LPN) preferred. Minimum 2 years of experience in home health quality assurance, OASIS auditing, or clinical coding. Strong understanding of Medicare Conditions of Participation, CMS guidelines, and ACHC/Joint Commission standards. Proficiency in ICD-10 and home health coding methodologies (HHRG/HIPPS). Excellent communication, analytical, and organizational skills. Bilingual (English/Spanish) preferred. Why Join Optima
Competitive salary based on experience Supportive and collaborative work environment Opportunities for professional growth and continuing education Commitment to innovation and excellence in patient care Seniority level
Entry level Employment type
Full-time Job function
Health Care Provider Industries
Hospitals and Health Care
#J-18808-Ljbffr