CDQI Audit Specialist
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Job Description
CDQI Audit Specialist auditing clinical documentation quality and compliance. Supporting Datavant’s healthcare data platform through feedback, education, and CDI program improvement.
Responsibilities:
- Conduct retrospective and concurrent audits of CDIQ Specialists’ work for documentation accuracy, compliant query generation, and appropriate capture of SOI, ROM, CC/MCC, and HCC
- Review missed opportunities affecting reimbursement, quality reporting, and patient outcomes
- Collaborate with physicians and caregivers regarding reimbursement and clinical severity for DRG-based payer patients
- Evaluate adherence to organizational workflows, policies, and industry standards
- Maintain audit tools, scoring methodologies, and audit documentation
- Provide individualized feedback and develop education plans based on audit findings
- Participate in onboarding and mentoring new CDQI staff
- Deliver educational presentations on documentation, coding, regulatory updates, and best practices
- Collaborate with the Physician Advisor regarding documentation opportunities and trends
- Monitor program performance indicators, including query rates, response rates, agreement rates, accuracy scores, case mix index impact, and CC/MCC capture rates
- Safeguard PHI, medical records, audit documentation, and company data in compliance with HIPAA and regulatory requirements
- Complete assigned audits within designated timeframes and produce actionable audit findings and educational feedback
Requirements:
- 5+ years of CDI experience and/or auditing
- 3+ years of clinical experience in an academic medical center
- RN or BSN with CCDS or CDIP certification
- Must pass CDI skills competency assessment
- Experience with various EMRs and CDI software, including Epic, Cerner, 3M, and Iodine
- Ability to function in a professional, efficient, and positive manner
- Strong organizational, teamwork, and communication skills
- Must be able to work in the United States
- This job is not eligible for employment sponsorship
Benefits:
- Total rewards strategy
- Post-offer health screenings and vaccinations as required by clients
- Reasonable accommodations for individuals with physical and mental disabilities
- Equal employment opportunity protections
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