Quality Assurance Coder

Optimal Care is where your dedication meets a rewarding career. 

As a clinician owned and operated company, we create the opportunity and environment for each employee to realize their highest potential while maintaining a personalized focus on our Patients and Families every day. We are the Midwest's premier provider of Physician Services, Home Health, and Hospice Care. Our integrated care delivery model incorporates technology, innovation and best practices. We produce value based outcomes by managing chronic disease process, rehabilitation and end of life care.

We live a simple Mission: Serve Together, Provide Value, and Deliver Exceptional Quality Care. 

What does this mean for you? At Optimal Care, you have our resolute commitment to being an exceptional place to work. Your expertise, passion and commitment to exceptional quality care will continue to thrive. With you we can build a remarkable place to work. 

Exceptional Benefits:

• Minimum of 3 Weeks Paid Time Off (PTO) 


• Company Vehicle Program 


• Flexible Work Schedule 


• Mentorship Culture


• Medical, Dental, and Vision Insurance 


• 401(k) with Employer Match


• Mileage Reimbursement 


• Cutting Edge Technology

Key Responsibilities 

As a Quality Assurance Coder, you'll ensure accurate coding for home care and hospice cases, supporting regulatory compliance, appropriate reimbursement, and most importantly - high-quality patient care.  This position is ideal for a detail-oriented coding professional who wants to apply their technical skills in a meaningful healthcare setting. You'll work closely with our quality assurance team to maintain coding accuracy across all cases while staying current with evolving regulations and guidelines.

What You'll Do

Apply Expert Coding Knowledge

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  • Apply ICD-10 diagnosis codes to patient conditions and disease processes using current coding guidelines
  
  
  • Identify and code the primary focus of care and terminal diagnoses along with all relevant comorbidities
  
  
  • Ensure accurate coding to support PDGM reimbursement and regulatory compliance
  
  
  • Maintain expertise in ICD-10-CM coding standards and stay current with updates
  
  
  
  

Review and Audit Documentation

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  • Review Face-to-Face documents for home health and hospice regulatory compliance
  
  
  • Use Face-to-Face documentation to identify focus of care for home health patients
  
  
  • Verify continuing criteria for eligibility for hospice patients
  
  
  • Audit medical records using critical thinking skills to ensure accuracy and completeness
  
  
  
  

Support Compliance and Quality

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  • Communicate significant findings, problems, and changes related to compliance standards to leadership
  
  
  • Monitor federal, state, and local regulations including CMS Conditions of Participation
  
  
  • Stay informed about Medicare, Medicaid, and third-party payor requirements
  
  
  • Identify and report potential payment coverage issues proactively
  
  
  
  

Manage Workflow and Process Improvement

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  • Track cases to ensure timely billing and regulatory compliance
  
  
  • Identify problematic coding sequences and provide solutions to prevent care disruptions
  
  
  • Prepare reports as directed by the Director of Quality Assurance
  
  
  • Participate in special audits as requested or assigned
  
  
  
  

Ensure Regulatory Compliance

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  • Maintain knowledge of changes in Conditions of Participation affecting quality improvement
  
  
  • Ensure adherence to all federal, state, local, and OSHA regulations
  
  
  • Support compliance initiatives across the organization
  
  
  • Contribute to continuous quality improvement activities
  
  
  
  

Required Qualifications

• High school diploma


• ICD-10 coding certification


• Minimum 3 years of quality assurance experience


• Current knowledge of ICD-10-CM coding guidelines


• Reliable transportation with valid automobile insurance

Essential Skills and Knowledge

• Expert knowledge of ICD-10 coding standards and regulations


• Strong understanding of home health care and hospice reimbursement (PDGM)


• Demonstrated decision-making and analytical skills


• Critical thinking abilities with attention to detail


• Effective verbal and written communication skills


• Strong interpersonal skills for collaboration with clinical and administrative teams


• Microsoft Office proficiency preferred


• Ability to interpret and apply complex regulatory requirements

What Makes You Successful

You're a coding specialist who takes pride in accuracy and understands that proper coding is essential to both reimbursement and quality patient care. You have a sharp eye for detail and the critical thinking skills to identify issues before they become problems.  You're proactive about staying current with regulatory changes and coding updates, viewing ongoing education as an essential part of your professional practice. You can work independently while also collaborating effectively with quality assurance specialists and clinical staff.  You're organized and process-oriented, able to manage your workflow efficiently while maintaining the highest standards of accuracy. You understand the bigger picture - that your work supports compliance, financial integrity, and ultimately, excellent patient care.

Work Environment

This is primarily an office-based position with occasional travel to branch locations for audits or educational events. The role involves extended periods of computer work in a comfortable, professional setting as part of a collaborative quality assurance team.

Location 

• Office Location: Jackson, MI


• This is a remote position for those located in Michigan, Indiana, Ohio, Texas, or Mississippi only

Hours 

• 8:00 am – 5:00 pm, Monday through Friday