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Apply ICD-10 diagnosis codes to patient conditions per current guidelines; determine primary focus and relevant comorbidities
Review and audit Face-to-Face documents for home health and hospice regulatory compliance; ensure eligibility criteria for hospice
Monitor regulatory requirements, support compliance initiatives, track cases for timely billing, and prepare directed reports
Must-have skills
ICD-10 coding certification with at least 3 years of quality assurance experience
Strong knowledge of ICD-10-CM coding guidelines and home health/hospice reimbursement (PDGM)
Detail-oriented with critical thinking, interpretation of complex regulations, and effective written/verbal communication
Nice-to-haves
Microsoft Office proficiency; strong collaboration with clinical and administrative teams
Ability to identify and propose solutions to coding issues; proactive regulatory update tracking
Location & work type
Office location: Jackson, MI
Remote eligibility: remote for candidates in Michigan, Indiana, Ohio, Texas, or Mississippi; otherwise on-site/workable hybrid possible
Hours: 8:00 am–5:00 pm, Monday–Friday
Full Description
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
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
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
ICD-10 CodingQuality AssuranceRegulatory ComplianceCritical ThinkingAttention to DetailCommunication SkillsInterpersonal SkillsAnalytical SkillsHome Health CareHospice CareDocumentation ReviewWorkflow ManagementProcess ImprovementCoding StandardsReimbursement KnowledgeMicrosoft Officereview:company
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
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
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
Background Screening
Optimal Care conducts a background screening upon acceptance of a contingent job offer. Background screening is completed by a third-party administrator, the Michigan Long-Term Care Partnership, and is performed in compliance with the Fair Credit Report Act.
Reasonable Accommodations
We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.
Equal Opportunity Employer
Optimal Care is an equal-opportunity employer.
