Clinical Documentation Reviewer — Home Health Pre-Claim Review & QA Virtual Assistant

We are a growing home health agency in Ohio looking for an experienced and detail-oriented Clinical Documentation Reviewer to join our team as a remote, full-time Pre-Claim Review & QA Virtual Assistant. This is a remote, full-time position where you will play a key role in reviewing patient charts, OASIS assessments, and visit notes to ensure clinical documentation supports Medicare home health coverage before we submit pre-claim review requests under the Review Choice Demonstration (RCD).

RESPONSIBILITIES:

Conduct pre-claim review chart audits for Medicare home health 30-day billing periods under the Review Choice Demonstration (RCD)
Review clinical documentation, OASIS assessments, and visit notes for completeness, accuracy, and Medicare compliance
Verify face-to-face (F2F) encounter documentation, including date of encounter, certifying practitioner signature, and supporting narrative for homebound status and skilled need
Validate physician-signed plan of care (POC) and physician certification/recertification documents
Confirm homebound status documentation meets Medicare criteria
Confirm skilled need and medical necessity are clearly supported in clinical notes
Prepare and submit Pre-Claim Review Requests (PCRR) through the Palmetto GBA portal / esMD
Track PCR decisions (affirmed, partially affirmed, non-affirmed) and coordinate timely resubmissions with corrected or additional documentation
Identify documentation gaps and follow up with clinicians, schedulers, and coordinators to obtain missing items before billing
Perform quality assurance (QA) chart reviews to catch documentation, coding, and compliance issues prior to claim submission
Maintain organized, HIPAA-compliant audit trails and tracking logs
Generate weekly status reports on pre-claim review affirmation rates, denials, and aging items for management
Stay current on CMS, RCD, and Palmetto GBA policy updates

REQUIREMENTS:

Minimum 2 years of clinical documentation experience (RN, LPN, MDS coordinator, chart abstractor, utilization review nurse, or similar role), ideally in home health or post-acute care
Strong understanding of Medicare home health coverage criteria (homebound, skilled need, face-to-face, plan of care, OASIS)
Familiarity with the Review Choice Demonstration (RCD) and pre-claim review submission workflow
Hands-on experience with a home health EMR (HCHB, WellSky, MatrixCare, Axxess, or similar) is strongly preferred
Working knowledge of OASIS data sets and home health visit note documentation
Strong attention to detail, especially with clinical documentation and compliance
Excellent written and verbal English communication skills
Ability to work independently, stay organized, and meet deadlines
Reliable high-speed internet connection and a quiet, professional work environment
Proficiency with Google Workspace and/or Microsoft Office

WHAT WE OFFER:

Competitive salary based on experience
Stable, long-term remote work opportunity with a growing home health company
Supportive team environment with clear communication and expectations
Opportunity to grow with the company

If you are interested in this position and meet the above criteria, please submit your resume, a brief description of why you believe you would be a good fit for this role, and a short video of you telling us why you are the best and what sets you apart from the others. You must submit a video and you must have the subject line of your application include the phrase: "Your problems are over".