Clinical Quality Analyst

Job Description:

The Position: Clinical Quality Analyst

The Clinical Quality Analyst is responsible for reviewing and analyzing clinical documentation for PT, OT, and ST services in HCHB. This role supports documentation quality, compliance, clinical trends, audit readiness, and education planning through review of records in HCHB/PointCare.

The Clinical Compliance Analyst will assess documentation for skilled needs, medical necessity, homebound criteria, timeliness, accuracy, and compliance with agency, payer, and regulatory requirements.

Qualifications:

• Current PT, OT or SLP License in New York
• Clinical background preferred, such as PT, OT, or ST with home health experience.
• Minimum of 2–3 years of experience in home health, rehab services, clinical documentation review, quality assurance, compliance, or healthcare analytics preferred.
• Experience with HCHB/PointCare.
• Strong understanding of home health documentation requirements, skilled need, medical necessity, homebound criteria, recertification, discharge planning, NOMNC, supervisory visits, and therapy plan of care requirements.
• Proficient with Microsoft Excel, Outlook, Teams, and reporting tools.

What We offer:

• Comprehensive benefits including medical, dental, and vision
• 401K plan with company match
• Robust time off including sick, vacation, personal days, cultural Heritage Day and your birthday off
• Opportunity for advancement
• Employee discount program on events, movie tickets, mobile phone plan discounts and more.

Responsibilities:

• Review clinical documentation in HCHB/PointCare for PT, OT, and ST services, including evaluations, recertifications, subsequent visits, discharges, NOMNC, supervisory visits, and coordination notes.
• Conduct a minimum of 35 clinical documentation and utilization review audits weekly to ensure therapy services are appropriate, medically necessary, skilled, homebound-supported, and aligned with the plan of care.
• Analyze documentation to ensure skilled need, medical necessity, functional deficits, objective findings, patient response, plan of care, and continued need for services are clearly supported.
• Review homebound documentation to confirm the record supports the patient’s inability to leave the home without considerable and taxing effort.
• · Review documentation related to home health aide needs, including functional limitations, safety concerns, caregiver support, and interdisciplinary coordination.
• Monitor supervisory visit compliance for PT/PTA and OT/COTA, including timely completion, communication, and plan of care review.
• Identify documentation gaps, compliance risks, incomplete documentation, late documentation, visit duration concerns, missed visit patterns, and recurring clinical trends.
• Analyze clinical documentation trends across PT, OT, ST disciplines, visit types, branches/regions, payer sources, and patient populations.
• Track and report trends related to evaluations, recertifications, subsequent visits, discharges, NOMNC completion, homebound documentation, supervisory visits, late documentation, incomplete documentation, missed visits, and visit duration concerns.
• Prepare reports, dashboards, and clinical trend summaries for Rehab Leadership, Compliance, Quality Assurance, and Education team.
• Support internal audits, appeal preparation, corrective action follow-up, and documentation improvement initiatives.
• Monitor patterns in documentation that may impact billing support, medical necessity, audit readiness, patient care quality, or regulatory compliance.
• Collaborate to identify education needs and assist with job aides, templates, clinical resources, and follow-up communication.
• Escalate high-risk documentation or compliance concerns to Director of Education and Compliance in a timely and objective manner.

The Clinical Quality Analyst is expected to support accurate, compliant, and high-quality therapy documentation through consistent HCHB/PointCare review, clinical trend analysis, objective reporting, and collaboration with clinical, compliance, quality, and education teams.

Americare is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee based on race, color, sex, gender, pregnancy, religion, age, creed, marital and partnership status, national origin, ancestry, alienage, past or present physical or mental disability, genetic information, sexual orientation, gender identity, affectional preference, veteran or military status or citizenship status, or any other legally recognized protected basis under federal, state, or local law.