Quality Nurse - QAPI Coordinator

Job Description

Job Description

Reports To : Program Director
Department : Clinical Operations / Quality Assurance
FLSA Status : Exempt or Non-Exempt (based on organizational structure)

Position Summary

The Quality Nurse – QAPI Coordinator is responsible for supporting and managing the organization’s Quality Assurance and Performance Improvement (QAPI) program under the direction of the Program Director. This role focuses on clinical quality oversight, regulatory compliance, provider education, documentation integrity, and continuous performance improvement initiatives.

The Quality Nurse will conduct clinical chart audits, review documentation for accuracy and compliance, ensure appropriate ICD-10 and CPT coding practices, and support adherence to Medicare and state regulatory requirements. The position serves as a key resource to providers and clinical staff in maintaining high standards of patient care, documentation quality, and operational compliance.

Essential Duties and Responsibilities:

QAPI Program Management:

• Assist in the development, implementation, and ongoing management of the organization's QAPI program.
• Monitor quality metrics, identify trends, and recommend corrective actions or process improvements.
• Participate in quality assurance meetings and performance improvement initiatives.
• Track quality indicators, provider compliance metrics, and audit outcomes.
• Prepare reports and summaries for leadership review.

Clinical Chart Audits & Documentation Review:

• Conduct routine and focused chart audits for completeness, accuracy, and regulatory compliance.
• Review medical documentation to ensure adherence to CMS guidelines.
• Audit provider documentation for appropriate clinical charting standards.
• Ensure timely and accurate uploading, organization, and maintenance of medical records.
• Identify deficiencies and communicate findings to providers and leadership.

Coding & Billing Compliance:

• Review clinical documentation for appropriate ICD-10 diagnosis coding and CPT procedure coding.
• Collaborate with providers and billing teams to improve documentation specificity and coding accuracy.
• Identify coding trends, denials, and compliance risks.
• Assist in reducing billing errors and improving reimbursement integrity.
• Maintain knowledge of current coding regulations and payer requirements.

Provider & Staff Education:

• Educate providers and clinical staff on:
  • Clinical documentation standards.
  • CMS and payer requirements.
  • ICD-10 coding accuracy.
  • CPT billing compliance.
  • Medical necessity requirements.
  • Best practices in wound care documentation and charting.
• Provide ongoing feedback and training based on audit findings and regulatory updates.

Regulatory & Compliance Oversight:

• Ensure organizational compliance with CMS, CLIA, Medicare, and applicable state regulations.
• Manage CLIA applications, renewals, updates, and documentation requirements.
• Coordinate Medicare enrollment applications, renewals, revalidations, and related compliance activities.
• Maintain readiness for audits, surveys, and regulatory reviews.
• Assist with policy and procedure development and updates.

Additional Responsibilities:

• Collaborate with interdisciplinary teams to improve clinical workflows and patient outcomes.
• Maintain confidentiality and HIPAA compliance at all times.
• Support special projects and additional compliance initiatives as assigned by leadership.

Qualifications:

• Active Registered Nurse (RN) license in the State of Arizona required.
• Bachelor of Science in Nursing (BSN) preferred.
• Minimum of 3–5 years of clinical nursing experience required.
• Experience in quality assurance, compliance, utilization review, wound care, or healthcare administration preferred.
• Strong knowledge of:
  • CMS regulations.
  • Medicare documentation requirements.
  • ICD-10 and CPT coding.
  • Medical record auditing.
  • CLIA compliance.
  • Healthcare quality improvement processes.
• Certified Professional Coder (CPC), Certified Professional in Healthcare Quality (CPHQ), or wound care certification preferred.

Skills & Competencies:

• Strong analytical and organizational skills.
• Excellent written and verbal communication abilities.
• Ability to educate and coach providers in a collaborative manner.
• Detail-oriented with strong critical thinking skills.
• Proficiency with EMR systems and Microsoft Office applications.
• Ability to manage multiple projects and deadlines independently.