QA Specialist - Inpatient/Outpatient Coding

Position Summary:
The QA Specialist is responsible for ensuring the accuracy, compliance, and integrity of coding and clinical documentation across Inpatient and Outpatient settings. This role will focus on auditing ICD-10-CM/PCS/CPT/HCPCS codes, and IRF-PAI submissions to validate adherence to regulatory requirements, payer guidelines, and organizational standards. The QA Specialist collaborates with coders, clinical teams, and leadership to identify trends, provide feedback, and implement process improvements that enhance coding accuracy, optimize reimbursement, and minimize compliance risk.

Key Responsibilities:

• Audit Inpatient, Outpatient, and IRF-PAI coded records for accuracy, compliance, and completeness.
• Validate ICD-10, CPT, HCPCS, and IRF-PAI coding/documentation against guidelines and payer rules.
• Provide feedback and education to coders and clinicians on audit findings.
• Track and report audit results, error trends, and coder performance.
• Ensure compliance with CMS, OIG, HIPAA, and payer requirements.
• Collaborate with coding, CDI, and revenue cycle teams to improve documentation and coding practices.
• Support readiness for regulatory updates and external audits.

Qualifications:

• CCS, CPC, CIC, or CCA certification; additional IRF-PAI training/certification preferred.
• 12 months in coding and/or auditing Inpatient, Outpatient, and/or Rehab records; strong knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding systems.
• Strong knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRGs, APCs, and IRF-PAI requirements.
• Excellent analytical, communication, and reporting skills proficiency with EHR and coding/auditing software.

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider.

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