Clinical Documentation Integrity, Claims Auditor
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Job Description
Clinical documentation auditor reviewing medical records and ICD-10-CM coding for Devoted Health’s Medicare-focused care platform. Supporting provider education and risk-adjustment quality.
Responsibilities:
- Perform medical record audits based on organizational priorities, including concurrent Clinical Documentation Improvement workflows and retrospective auditing
- Conduct coding reviews and audits that may result in the addition, deletion, adjustment or confirmation of diagnoses
- Review audit results with the CDI Manager
- Assist in creating and communicating provider and vendor education regarding coding trends and compliant coding opportunities
- Assist the CDI Manager with recommendations for process improvements to enhance coding quality goals and outcomes
- Handle related duties, including provider education and training and working with vendor partners
- Meet with and educate providers and support staff in office locations during domestic travel
- Remain current on ICD-10-CM coding guidelines, AHA Coding Clinic guidance and CMS Risk Adjustment guidance
Requirements:
- BA/BS in Nursing preferred but not required
- 3+ years as an outpatient CDI or 5+ years in risk adjustment coding/auditing
- CPC or CRC certification through AAPC or CDI or CCS certification through AHIMA
- Prior CPT coding a plus
- Strong analytical and problem solving skills
- Strong oral and written communication skills
- Strong organization and time management skills
- Ability to work independently
- Ability to multi-task
- Remain current on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and CMS Risk Adjustment guidance
- Some domestic travel required
- Full-time employees are eligible for the total rewards package
Benefits:
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
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