Home Health RCM QA & Intake Coordinator (CPC Required)
Job ID: JOB-119
Company: OptiClaim Business Solutions
Location: Remote
Job Type: Remote
Experience Required: 3 -5 Years
Salary Range: Discussion
Posted Date: 02-02-2026
Job Description
About OptiClaim
OptiClaim Business Solutions LLP is a US healthcare operations and revenue-cycle support company working closely with Medicare-certified Home Health agencies across the United States. We specialize in quality assurance, documentation integrity, intake coordination, and revenue-impacting operational workflows.
We are expanding our Home Health operations team and are looking for a CPC-certified professional with hands-on US Home Health experience to support QA-led intake and compliance workflows.
Role Overview
OptiClaim is seeking a QA & Intake Operations Specialist with 3–5 years of US Home Health experience and an active CPC (AAPC) certification.
This is a non-clinical, operations-focused role responsible for ensuring that intake, documentation, and coordination activities are complete, compliant, and billing-ready, with a clear understanding of how documentation quality affects Medicare billing, PDGM payments, and audits.
Key Responsibilities
Quality Assurance & Documentation (Primary Focus)
Perform QA reviews of Home Health charts for documentation completeness and billing readiness
Track and follow up on:
missing or late visit notes
incomplete or pending OASIS
unsigned physician orders
missing or delayed Face-to-Face (F2F) documentation
therapy Plans of Care (PoCs)
Apply checklist-based QA processes aligned with Medicare and payer requirements
Identify documentation gaps early to prevent claim delays, denials, or takebacks
Maintain organized records to support audit and survey readiness
Coding & Billing (CPC-Level QA Validation)
Apply CPC-level knowledge to validate documentation against billing and compliance requirements
Review and validate ICD-10-CM diagnoses commonly used in Home Health (chronic conditions, post-surgical aftercare, wound care, neuro, cardiac, etc.)
Demonstrate working awareness of:
Medicare Home Health PDGM payment model
Revenue codes (e.g., 042x–058x)
HCPCS Q-codes (e.g., Q5001, Q5002 – place of service)
Flag documentation, diagnosis, or timing risks that may impact claims or reimbursement
Coordinate with billing teams to resolve documentation issues before claim submission
Intake & Admission Coordination
Support referral intake and data entry in Home Health EMRs (Axxess preferred)
Coordinate eligibility verification and admission readiness
Review referral diagnoses and skilled needs for Home Health appropriateness
Follow up on incomplete referral packets
Communicate with referral sources, clinicians, and physician offices
Coordinate therapy referrals and documentation flow
Maintain accurate tasking, notes, and updates within the EMR
Required Qualifications
3–5 years of experience in US Home Health operations
Active CPC certification (AAPC) – mandatory
Prior experience in one or more of the following:
QA / documentation review
Billing or revenue cycle support
Intake or referral coordination
Strong understanding of:
Medicare Home Health workflows
OASIS, orders, and F2F requirements
How documentation quality impacts billing and audits
Hands-on experience with Home Health EMRs (Axxess preferred)
Experience coordinating with clinicians (RN/PT/OT/ST) and physician offices
Preferred Skills
Working knowledge of:
ICD-10-CM (Home Health context)
PDGM payment structure
Therapy coordination workflows (PT/OT/ST)
Strong follow-up and tracking discipline
Ability to manage multiple open items with high attention to detail
Soft Skills
Clear spoken and written English
Comfortable communicating with US-based teams and physician offices
Strong attention to detail
Process-driven and organized
Professional and calm approach to follow-ups and escalations
Apply / Contact: ak@opticlaim.com
Contact Number: +91 9880172872
Application Deadline: 05 Feb 2026
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