Healthcare VA (Nurse)

Role: Healthcare VA (Nurse)

Salary: Competitive Basic Salary

Benefits: HMO plus 2 free Dependents, P1,500 Rice Allowance, Night Differential.

Shift schedule: Monday to Friday, 11:00 p.m. to 8:00 a.m. Philippine Time

Work Setup: Work from Home

Job Summary:

We are looking for a Healthcare VA - Nurse with expertise in Quality Assurance (QA) and Compliance to remotely review and audit clinical documentation in accordance with CMS guidelines, QUAPI standards, and federal Medicare regulations. 

The ideal candidate will have a strong background in hospice and palliative care documentation, ensuring accuracy, regulatory compliance, and quality improvement.

Job Duties and Responsibilities: 

Review and Audit Clinical Documentation:

• Conduct thorough QA reviews of clinical notes to ensure compliance with Conditions of Participation (CoPs), Medicare guidelines, and CMD (Clinical Medical Director) standards.
• Identify documentation deficiencies and provide feedback to clinical staff for correction.

Ensure Compliance with Federal and Medicare Regulations:

• Maintain up-to-date knowledge of Medicare, Medicaid, and other payer regulations for hospice and palliative care services.
• Ensure patient eligibility criteria are met according to CMS and hospice guidelines.

QUAPI (Quality Assessment and Performance Improvement) Oversight:

• Assist in the development, implementation, and monitoring of Quality Assurance and Performance Improvement (QAPI) initiatives.
• Identify trends and recommend improvements to enhance documentation quality and regulatory compliance.

Collaborate with Clinical Teams:

• Provide education and training to nurses and other clinical staff on proper documentation practices.
• Work closely with compliance officers, medical directors, and administrators to align QA processes with best practices.

Monitor Documentation for Billing Compliance:

• Ensure documentation supports medical necessity, level of care, and billing accuracy for Medicare and private payers.
• Assist in pre-bill audits to reduce claim denials and ensure timely reimbursement.

Job Qualifications: 

• Registered Nurse is a plus
• Minimum 2+ years of experience in hospice, palliative care, or home health. (US-based)
• Strong knowledge of CMS guidelines, Medicare regulations, and QUAPI standards.
• Experience with electronic medical records (EMR) and auditing documentation for compliance.
• Familiarity with ICD-10 coding, Medicare hospice eligibility, and plan of care requirements.
• Excellent attention to detail with the ability to identify and correct errors in documentation.
• Ability to work independently in a remote setting while meeting deadlines.

Preferred Qualifications: 

• Experience in quality assurance, compliance, or clinical auditing.
• Knowledge of Medicare hospice reimbursement models and billing processes.
• Proficiency in hospice EMR systems (such as WellSky, Homecare Homebase, or Axxess).