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A healthcare software company helping you deliver whole-person, value-based care.
QA Specialist
Location
United States
Posted
78 days ago
Salary
0
Seniority
Senior
Job Description
QA Specialist
Netsmart
• Oversee Coding & OASIS staff competency to ensure accuracy, consistency, and compliance with guidelines. • Develop and deliver new-hire orientation and ongoing training, including client-specific processes and updates. • Conduct Quality Assurance (QA) reviews, document findings, identify trends, and collaborate closely with QARs performing day‑to‑day QA. • Serve as the expert resource for complex Coding & OASIS questions and maintain updated knowledge resources. • Partner with managers, clients, and internal teams to support client onboarding, quality discussions, and process alignment. • Work collaboratively with both stateside and offshore (India-based) review teams to support training, quality standards, and workflow consistency. • Test and provide feedback on McBee Clinical Review platform functionality. • Communicate quality concerns to all appropriate stakeholders and support resolution actions.
Job Requirements
- At least 4 years of experience in Coding & OASIS review
- HCS-D certification and HCS-O or COS-C OASIS certification
- Expert in ICD-10 coding and OASIS guidelines
- Proficient in home health industry regulations and guidelines
- Excellent communication and presentation skills
- Working knowledge of Microsoft Office
- Advanced clinical degree (preferred)
- Active clinical license (e.g., RN, PT, OT, SP) (preferred)
- CPHQ certification (preferred)
- HCS-H certification (preferred)
Benefits
- Netsmart provides equal employment and advancement opportunities to all individuals.
- Committed to creating an inclusive environment for all associates.
- Providing a healthy and safe workplace and maintaining a drug-free workplace.
- Pre-employment background check, including a drug screen which is provided at Netsmart’s sole expense.
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Job Summary: At REE, our Quality Assurance (QA) Specialists, serve as the last line of defense on accuracy, completeness, and compliance in the overall process of providing high quality medical evidence to our clients. The QA Specialists process any change requests and finalize all medical information provided on the completed Disability Questionnaire ensuring the upmost quality and accuracy to support the processing of disability claims for our clients. Our QA team members work alongside their peers within the overall Operations Department to ensure REE Medical maintains an excellent standard of service for our clients. What is expected in this Role: - Serving as a skillful Disability Benefits Questionnaire (DBQ) Quality Check Expert finalizing all pertinent information completed on the DBQ, ensuring total completion and accuracy of document in relation to departmental goals. - This includes reviewing and processing change requests determining which areas of the DBQ require updating, ensuring total completion and finalization of those requests, utilizing the Disability Rating Guide and ECFR ensuring updated DBQs meet quoted projections, and verifying disability rating requirements and criteria for aligned conditions. This can be hundreds of pages of medical documents on a day-to-day basis. This level of detail is a key part of your QA success. - This also includes formalizing all files and sending approved DBQs to clients. - This also includes ensuring all processes and procedures related to Compliance and the DBQ process are followed and safeguarding personally identifiable information / personal health information across the different communications both internally or externally. - This also means you are working diligently to meet or exceed all department established expectations and goals, such as the team's productivity goals, quality goals, timeline goals, error rate goals, completeness of file goals, internal tagging timeline goals, etc. while maintaining a daily productivity log. - Serving as a VA Rating Schedule expert, able to determine disability rating requirements and understanding which different criteria aligns best with the Client's conditions as you process change requests and update DBQs via provider or clinic feedback. - Communicating with all internal or external stakeholders appropriately confirming any additional information or other document clarifications are adjusted on the DBQ with accuracy and efficiency ensuring a high quality questionnaire is processed to the next step of the product lifecycle. - This can include external communications to providers, clinics, and clients addressing several areas within the DBQ process, such as provider updates, client questions, file content updates or statuses, concerns, and overall general DBQ support. Communications can vary, such as tagging, emailing, texting, and calling as needed. - Serving as the final qualify check in the completeness and accuracy of the completed DBQ, confirming all vital information impacting the validity of the medical evidence.




