Responsibilities

• Conduct reviews and provide recommended corrections of billed services for medical records, ensuring accuracy and compliance with current coding guidelines and regulations 
• Conduct DRG validation to ensure appropriate assignment based on clinical documentation and coding 
• Review and audit billed services, providing recommended corrections related to clinical documentation to maintain coding integrity 
• Assist in reviewing and responding to payer and governmental audits of billed services 
• Stay current with and apply new coding guidelines and codes, maintaining expertise in CPT, HCPCS, and ICD-10 coding systems 
• Meet established daily accuracy and production standards as per department policy 
• Collaborate with healthcare team members to ensure continuity of services and clarity in clinical documentation 

Qualifications

Required

• High school diploma or GED 
• One or more of the following credentials: Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA); or Certified Professional Coder (CPC) and Certified Outpatient Coder (COC) through the American Academy of Professional Coders (AAPC) 
• At least 1 year inpatient medical coding with DRG validation work experience 
• Strong analytical, interpersonal, and communication skills 
• Ability to produce detailed, comprehensive documentation and reports 
• Passing scores on job-related pre-employment assessments 

Preferred

• Experience in coding or medical billing quality control 

Expectations

• Comfortable with remote work arrangements and virtual collaboration tools  
• Physical demands include extended periods of sitting, computer use, and telephone communication 

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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