Home Health Coding and Quality Assurance Specialist

16 hours ago


Guilford, Connecticut, United States Yale-New Haven Health Full time
Job Summary

We are seeking a highly skilled and experienced Clinical Quality Assurance Specialist to join our team at Yale-New Haven Health. As a key member of our Home Health department, you will play a critical role in ensuring the highest quality of care for our patients.

Key Responsibilities
  • Conduct comprehensive clinical record reviews to ensure accurate and complete documentation, adhering to OASIS and regulatory requirements.
  • Collaborate with coding staff to ensure accurate and compliant documentation.
  • Develop and conduct educational training programs for clinicians and staff on OASIS requirements, clinical documentation, and regulatory compliance.
  • Utilize a compliant query process to identify and address documentation issues.
  • Prepare periodic reports and dashboards to support quality improvement initiatives.
  • Work collaboratively with clinical and administrative leadership to ensure positive and compliant program outcomes.
Requirements
  • Registered Nurse with active license, BSN preferred.
  • At least three years of recent clinical nursing experience, with a minimum of one year of OASIS QA review experience.
  • Excellent communication, negotiation, and organizational skills.
  • Comprehensive understanding of medical records and data extraction.
  • Working knowledge of third-party and prospective payment systems.
Accountability

As a Clinical Quality Assurance Specialist, you will be accountable for communicating effectively, adhering to Standards of Professional Behavior and High Reliability Organizations, and demonstrating a strong commitment to patient-centered care.

Complexity

This role requires a high level of complexity, including the ability to exercise independent judgment, tact, and diplomacy in dealing with physicians, clinicians, and other stakeholders. You will be responsible for serving as a resource on home care quality assurance processes and participating in the orientation of new staff.



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